Lizard Bite Masquerading as Scorpion Sting Envenomation

Lizard bite is very infrequent in children. Lizards tend to avoid confrontation. Bites are only inflicted when they are manipulated or when they are cornered and feel threatened. Lizard bites may be frightening but most do not cause serious health problems. The wall lizard or gecko, found in most homes, is not poisonous at all. It only checks indivt population. A two-year-old boy was brought with history of lizard bite over right hand when he was trying to capture it. The child had experienced excessive sweating and irritability within two hours of bite. He was treated with supportive care. Prazosin hydrochloride was administered in the dose of 30μ/kg as his symptoms mimicked the autonomic storm which is typically seen with scorpion sting envenomation. To the best of our knowledge autonomic storm following lizard bite has not been reported in the Indian literature so far.

A two-year-old male child born out of non-consanguineous marriage with normal developmental milestones till age, brought with history of excessive sweating and irritability following lizard bite. There was history of lizard bite over right hand two hours prior to admission while he was trying to capture the lizard. There was also a history of lizard bite to the right arm of mother, when she was attempting to dislodge the lizard from the baby’s hand.

Scorpion bite being a more common occurrence was ruled out while the parents were interviewed.

On examination, child was irritable with excessively perspiring with pulse rate of 160/min, Blood pressure of 140/112mm of Hg, respiratory rate of 50 breaths/min and temperature of 36.8^oC, with dilated pupils in both eyes [Table/Fig-1]. There was a erythema and tenderness over the bitten site on the right hand of a child. Mother had erythema of 2x2cm around the bitten site. The child was treated with intravenous fluid, oxygen and sedation. As the clinical features of adrenergic storm, like tachycardia, hypertension, tachypnoea, perspiration, and dilated pupils were present, the patient was treated with the first dose of prazosin hydrochloride in the dose of 30μ/kg. The child responded well to the first dose over next four hours with subsidence of adrenergic storm. Subsequent doses were not given.

There are around 3000 species of lizard that exists in the world [1]. There are only two venomous species of lizards i.e. the Glia monster, Heloderma suspectum and Mexican beaded lizard [2]. Both of them are not found in India. Envenomation by venomous lizards is very rare [3].

Lizard bites are very rare and usually occur following attempts to handle or capture them. In the olden days the breath or the urine of the lizard was considered poisonous [4] which is not true. Envenomation by poisonous variety results from contamination of the wound with neurotoxic venom [5]. It may cause tissue injury which manifest with local symptoms of severe pain, erythema, oedema. There can be systemic manifestations like nausea, vomiting, haemetemesis, dyspnoea, dysphoria and blurring of vision and generalized weakness. These manifestations may last for 72 to 96 hours. The treatment consists of infiltration of local anaesthetic to relieve pain, cooling of the bitten area, measures to prevent infection including tetanus toxoid [5]. Wound should be cleaned thoroughly and irrigated with antiseptic solution. There is no specific treatment other than reassurance to the person bitten by lizard in India [5].

Taksande AM et al., reported a lizard bite in Indian child presented with excessive crying, swelling and bleeding from the bitten site, who recovered without any complications [4]. Vikrant S and Verma BS reported acute kidney injury following monitor lizard bite [6]. Autonomic storm like features are usually seen with scorpion sting envenomation, but rare with lizard bite. Our patient with lizard bite presented mainly with autonomic storm, without much local symptoms over the bitten site and responded well to the first dose of prazosin hydrochloride.

Lizard bite can present with autonomic storm. Prazosin hydrochloride may be required to control the autonomic storm along with symptomatic and supportive treatment.

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