[Skin complications of stonefish envenomation in 6 travellers returning from the Indo-Pacific maritime region]

Abstract

Stonefish (Synanceja verrucosa) sting has been known for a long time to be a medical hazard. It is a common cause of severe marine envenomation. Immediate complications (collapsus, pulmonary oedema) have been described extensively. Late complications (oedema, tissue necrosis) have not been studied in details although they are common and a cause of invalidity and pain. We have observed six travellers with complications of stonefish sting over a 10 year-period in our department. All the patients were coming back from the Indo-Pacific maritime region. They presented with cutaneous abcess (in one) or necrotic complications (foot ulcers in two, cellulitis in three) associated with painfull oedema in two and lymphangitis in three. Surgery has been performed in four patients, two of them undergoing many operations. Two had long term sequelae. Such complications could be avoided. Appropriate initial treatment (i.e., neutralization of the venom by hot water, disinfection, antivenom and antibioprophylaxis) seems to be able to reduce late complications. Antivenom is indicated in severe systemic manifestations which are life threatening and in case of crucial pains. Prevention is the most important part of therapy and relies on appropriate information of the travellers.