What are the signs and symptoms of scorpion envenomation at the sting site?

Updated: Nov 09, 2018
  • Author: David Cheng, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Local evidence of a sting may be minimal or absent in as many as 50% of cases of neurotoxic scorpion stings. In fact, tissue necrosis is rarely found.

A sharp burning pain sensation at the sting site, followed by pruritus, erythema, local tissue swelling, and ascending hyperesthesia, may be reported. This paresthesia feels like an electric current, persists for several weeks, and is the last symptom to resolve before the victim recovers.

The tap test is administered by tapping at the sting site. A positive result is when the paresthesia worsens with the tapping because the site is hypersensitive to touch and temperature. In fact, wearing clothing over the area and sudden changes in temperature exacerbate the symptoms. Tapping over the injury site (ie, tap test) may cause severe pain after a sting by C exilicauda.

Cytotoxic local effects

A macule or papule appears initially at the sting site, occurring within the first hour of the sting.

The diameter of the lesion is dependent on the quantity of venom injected.

The lesion progresses to a purpuric plague that will necrose and ulcerate.

Lymphangitis results from the transfer of the venom through the lymphatic vessels.

Nonlethal local effects

Pain, erythema, induration, and wheal may be present.

These are secondary to venom activation of kinins and slow-releasing substances.

Local tissue effects vary among species. Minimal local tissue effects are present with Centruroides envenomation. Significant local tissue reaction rules out C exilicauda (C sculpturatus) envenomation.

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