Dermatological Progression of a Probable Box Jellyfish Sting

Abstract

This case report describes the typical features of the dermatological progression of a patient stung by a (probable) box jellyfish. The purpose is to guide clinicians and patients to an understanding of what to expect after such a sting using the clinical narrative and unique sequential photographs of the injury. With knowledgeable consultation from experienced physicians and meticulous care, this envenomation healed without the need for skin grafting.

Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat

“… Evolution of Cubozoan jellyfish stings: ( A )—brownish, erythematous tentacle marks a few hours after a cubozoan sting; ( B )—some weeks after the envenomation, the wound showed signs of infection and gangrene; ( C )—erythematous, linear marks on the day of the envenomation; ( D )—day 2, dark purple marks corresponding to the tentacle contact sites—right leg edema; ( E )—day 4, worsening edema of the right leg; ( F )—day 12, scab formation with exposure of textured granulation tissue underneath and serous exudate; ( G )—day 19, increased granulation tissue, the wound edges have started to re-epithelize; ( H )—day 24, the wound is healing by secondary intention; I)—wound appearance 120 days after the sting. ( A , B ) reproduced from [ 77 ], ( C – I ) from [ 141 ], with permission. …”

“…Vesiculourticarial, painful dermatitis Scyphozoa, Hydrozoa, Cubozoa [14,76] Scarring Scyphozoa, Cubozoa [77,78] Infection Scyphozoa, Cubozoa [79,80] Pruritus Scyphozoa [81] Delayed dermatitis Hydrozoa, Scyphozoa, Cubozoa [82][83][84][85][86][87][88][89] Recurrent dermatitis Scyphozoa, Hydrozoa [90][91][92][93] Parasympathetic actions Parasympathetic dysautonomia Cubozoa [94] Ileus paraliticus unknown [95] Urinary incontinence Cubozoa [94,96] Biliary dyskinesia Scyphozoa [96] Vascular spasm Hydrozoa [97][98][99] Sympathetic actions Mydriasis Scyphozoa [100] Blurred vision Scyphozoa [101] Stress cardiomyopathy Cubozoa, Scyphozoa [30,72] Irukandji syndrome Cubozoa [102][103][104][105][106][107][108] Neuromuscular actions Mononeuritis multiplex unknown [109,110] Peripheral neuropathy Scyphozoa, Cubozoa [99,[111][112][113]…”