Acute Respiratory Distress Syndrome and Neurotoxicity Following Scorpion Envenomation in a Child: A Case Report

Scorpion envenomation is a major health concern in North Africa, particularly in Morocco, where children are the most affected population. While most cases are mild, severe envenomation may lead to life-threatening complications such as cardiovascular collapse, acute respiratory distress syndrome (ARDS), and neurological involvement. We report a rare and severe case of a 3-year-old girl from a rural area near Fez who developed both ARDS and neurological symptoms following a scorpion sting. Initially presenting with agitation and confusion, the patient experienced rapid neurological deterioration requiring intubation and intensive care. Despite an initial recovery and successful extubation, she developed acute hypoxemic respiratory failure within 24 hours, leading to a diagnosis of ARDS. Management included sedation, protective mechanical ventilation, prone positioning, and restrictive fluid therapy. With optimized supportive care, the patient demonstrated full recovery without sequelae. No antivenom was administered, reflecting current Moroccan practice due to concerns regarding local efficacy. This case illustrates the potential severity of pediatric scorpion envenomation and the importance of rapid, multidisciplinary intervention. It also emphasizes the need for early recognition of complications, particularly in rural settings where delayed access to care may worsen prognosis. The simultaneous occurrence of ARDS and central neurotoxicity remains rare but clinically significant, underlining the venom’s potent cardiopulmonary and neurotoxic effects. Although the prognosis can be favourable with prompt intensive care, this case highlights the necessity for region-specific antivenom development and further research into early predictors of severe envenomation. Our findings contribute to the limited literature documenting combined respiratory and neurological complications of scorpion envenomation in children and advocate for improved clinical protocols and public hea