Successful treatment of jellyfish sting-induced severe digital ischemia with intravenous iloprost infusion

Abstract

Jellyfish sting-induced vasospasm and vasculitis is a rare complication that could lead to severe digital ischemia and gangrene. We report a 39-year-old woman with severe pain in her right middle, ring, and little fingers after being stung by a jellyfish. Therapy was initiated with a course of intravenous iloprost infusion and subcutaneous low-molecular-weight heparin, with successful revascularization. Our case illustrates that although emergency transfer to a vascular center is ideal, even in a delayed setting, patients can still benefit from specialist vascular care with a combination of medication and iloprost treatment, with acceptable functional outcome.

Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation

“…The use of color or power Doppler imaging is crucial to rule out vessel contraction disorders potentially leading to ischemia, such as severe vasospasm induced by jellyfish stings. 13,14 In conclusion, most patients affected by jellyfish stings show immediate symptoms, which usually resolve within a few minutes or hours. However, delayed clinical presentation is also possible, and clinicians should be aware of it.…”

“…This could have been related to vasoconstriction associated with jellyfish stings or limitations in the Doppler mode of our equipment. The use of color or power Doppler imaging is crucial to rule out vessel contraction disorders potentially leading to ischemia, such as severe vasospasm induced by jellyfish stings …”

Dermatological Progression of a Probable Box Jellyfish Sting

“…Other syndromes that are seen after jellyfish envenomation include vasospasm and vasculitis, 26 digital ischemia, 27 local skin necrosis, and hyper- or hypopigmentation. The long-term sequelae may involve months of intermittent skin desquamation, discolored striae, and pruritus.…”

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

“…Other systemic reactions Acute renal failure Hydrozoa [120] Arrythmia Hydrozoa [121] Rhabdomyolysis Hydrozoa [122,123] Erythema nodosum Hydrozoa [124] Deep venous thrombosis Scyphozoa [125] Facial swelling unknown [126,127] Digital necrosis unknown [128][129][130] Spinal cord infarct unknown [131] Cellulitis Scyphozoa [79] Myalgia Scyphozoa, Cubozoa [132] Abdominal cramping Scyphozoa, Cubozoa [13,119] Cough Scyphozoa [13,119] Nausea and vomiting Hydrozoa [133] Cold sweating Hydrozoa [133] Delayed eye swelling unknown [134] Long term reactions Keloids Cubozoa [71,73] Lichen planus unknown [135] Hyperpigmentation Scyphozoa, Hydrozoa, Cubozoa [78,86,136] Fat atrophy unknown [137] Delayed necrosis Cubozoa [82] Gangrene Cubozoa [138] Persistent hypersensitivity Scyphozoa [139] Koebner Phenomenon unknown [140] Persistent neuropathy unknown [111] Granulomatous infiltration Cubozoa [87] Nodular papular eruption Cubozoa [84] Potentially fatal reactions Immediate cardiac arrest Cubozoa [141][142][143] Acute myocardial infarction unknown [29,31] Rapid respiratory arrest Cubozoa, Scyphozoa…”