Lionfish envenomation

Background

• Number of camouflaged bottom-dwelling fish fish species within family Scorpaenidae, mostly found in the Indo-Pacific
• Also called zebrafish, firefish, turkeyfish, tastyfish or butterfly-cod
• The fish have alternating brown, to orange and white stripes or spots.
• They are common to home aquariums & account for the majority of spiny fish related calls to the poison control center in the U.S.
• Fins have spine connected to venom glands which inject venom when agitated

Clinical Features

Edema and erythema in the right hand of a patient two hours after puncture in the middle finger.

Edema and erythema on the index and medium fingers of the right hand after sting to index finger.

• Local erythema, ecchymosis, swelling, & variable skin changes (e.g. pallor vs. erythema vs. cyanosis)
• Intense, sharp pain
• Symptoms peak at 60-90 minutes
• Duration: 1-2 days
• Lesions can progress to hemorrhagic bullae with necrosis.
• Systemic effects are similar to stonefish.

Differential Diagnosis

Marine toxins, envenomations, and bites

• Toxins
  • Ciguatera
  • Scombroid
  • Tetrodotoxin (e.g. pufferfish)
  • Shellfish poisoning
    • Amnesic shellfish poisoning
    • Diarrheal shellfish poisoning
    • Neurotoxic shellfish poisoning
    • Paralytic shellfish poisoning
• Stingers
  • Stingray injury
• Venomous fish
  • Cone shell
  • Lionfish
  • Sea urchins
  • Crown-of-Thorns Starfish
  • Stonefish
  • Other: Catfish, zebrafish, scorpion fish
• Nematocysts
  • Coral reef
  • Fire coral
  • Jellyfish (Cnidaria)
    • Box jellyfish
      • Irukandji syndrome
    • Sea wasp
  • Portuguese man-of-war
  • Sea anemones
  • Seabather's eruption
• Phylum porifera (sponges)
• Bites
  • Alligator and crocodile attacks
  • Octopus bite
  • Shark bite
• Infections
  • Vibrio species in saltwater
  • Aeromonas species in freshwater

Evaluation

• Clinical diagnosis, no specific testing available
• Consider radiography as retained foreign bodies are common

Management

• Clean wound, update tetanus, remove retained tissue
• One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial
• Immerse extremity in hot water (45 C) for 30-60 minutes

Disposition

Patients should be observed for 6-12 hours.

See Also

• Marine toxins and envenomations