A fatal case of Jaguajir rochae scorpion sting in Brazil due to allergic reaction

Death and serious morbidity are known from scorpion stings from a few species, especially in the family Buthidae. Most of not all cases are caused by the toxic effect of the venom. Serious morbidity caused by allergic reactions to the venom is known from many venomous animals, but rarely reported in scorpions.

Iva Maria Lima Araújo Melo and co-workers have recently reported about a fatal case in Brazil where a man died after been stung by Jaguajir rochae (Borelli, 1910) Buthidae). This species was formerly in the genus Rhopalurus Thorell, 1876. Sting of Jaguajir/Rhopalurus have been considered mildly, and the few case reports that exist describe a mild course.

The present case had a very rapid course and the patient died before arriving to a hospital. All factors point to an allergic reactions as cause of death. The patient had a history of allergic reactions attributed to bee stings, and a cross reaction may explain why this patient develop such serious symptoms. Previously, a death from anaphylaxis due to a sting from Centruroides exilacauda has been reported from USA.

In conclusion, even though it is probably rare, sting from assumed harmless species may cause life-threatening allergic reactions. Especially in peoples with allergies.

Abstract:
A 44-year-old healthy farmer, was stung by a scorpion on his right hand while preparing soil for planting in the Caatinga area (a large area in the north-east of Brazil characterized by semiarid scrub forest), in the Catarina Municipality countryside, Ceará State, Brazil. According to the reports of carers and family members, the patient initially reported mild pain at the site of the sting, but within a few minutes he developed malaise, pruritus in the body and throat, edema in the nostrils, and a dry mouth which led to looking for water to drink. It rapidly evolved into sphincter, urinary and fecal release, salivation and a convulsive episode with loss of the senses. He was dead on arrival at Catarina Municipality Hospital emergency department. The necroscopic report indicated suffocation due to glottal edema and acute lung edema as the “cause of death”. The animal which caused the accident was under a rock that the patient was manipulating at the time of the incident, and has been identified by experts as Jaguajir rochae (Borelli, 1910) scorpion species, formerly synonymized Rhopalurus rochae. This is the first report of a fatality due to an allergic reaction to the venom of this species. This leads to the possibility that deaths caused by stings from other scorpion species may be due to anaphylaxis, whose symptoms in some situations may be confused with severe envenomation.

Reference: 
Melo IMLA, Ramalho RD, Bezerra MMV, de Oliveira Filho IE, Medeiros CR, da Costa Gadelha MA, et al. Fatal anaphylaxis to Jaguajir rochae (borelli, 1910) (Scorpiones, Buthidae) in Brazil: A case report. Journal of Tropical Pathology. 2019;48(3):1-8. [Open Access]