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Case Reports
. 2025 Oct;12(5):3780-3784.
doi: 10.1002/ehf2.15368. Epub 2025 Jul 4.

Cardiogenic shock requiring VA-ECMO therapy in scorpionism-induced myocarditis

Alba I Violino  1 , María Alicia Lozano  1 , Rocio Garcia Moralez  1 , Juan P Ricarte-Bratti  1   2 , Julieta Lozita  2 , Elizabeth Y Ravinovich  2
Affiliations
Case Reports

Cardiogenic shock requiring VA-ECMO therapy in scorpionism-induced myocarditis

Alba I Violino et al. ESC Heart Fail. 2025 Oct.
No abstract available

Keywords: ECMO; Tityus trivittatus; cardiogenic shock; case report; myocarditis; scorpionism.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Chest computed tomography (CT) images in coronal (top row) and axial (bottom row) planes. The coronal images show bilateral ground‐glass opacities and patchy areas of consolidation, with predominant involvement of the right lung. Axial sections further highlight diffuse interstitial and alveolar involvement, suggestive of acute pulmonary oedema.
Figure 2
Figure 2
Specimen of Tityus trivittatus recovered from the patient's home environment. This species is one of the most medically significant scorpions in Argentina and is known to produce severe systemic envenomation, particularly affecting the cardiovascular and autonomic nervous systems.
Figure 3
Figure 3
Cardiac magnetic resonance (CMR) imaging findings consistent with acute non‐ischaemic myocarditis.(A) T2‐weighted short tau inversion recovery (STIR) sequence showing increased signal intensity in the anterolateral wall, compatible with myocardial oedema. (B) Native T1 mapping with diffusely elevated relaxation times (mean 1285 ms; normal range: 950–1050 ms) and (C) extracellular volume (ECV) map with globally increased ECV fraction (mean 38%; normal range: 22%–29%), indicating diffuse myocardial interstitial expansion and inflammation. (D) Four‐chamber view late gadolinium enhancement (LGE) image showing subepicardial enhancement in the inferolateral midventricular wall and at the inferior right ventricular insertion point, characteristic of non‐ischaemic myocarditis. (E) LGE short‐axis view confirms the limited, subepicardial distribution of enhancement in the anterolateral and inferolateral walls. These findings, in the context of preserved biventricular volumes and function, fulfil the updated Lake Louise Criteria for acute myocarditis and are supported by increased native T1, T2 and ECV values as well as the presence of non‐ischaemic LGE patterns.
See this image and copyright information in PMC

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