Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation

Abstract

Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow-ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow-up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow-up of cutaneous lesions in these cases.

Differences in itch and pain behaviors accompanying the irritant and allergic contact dermatitis produced by a contact allergen in mice

“…Ultrasound imaging and blood flow measurements have been used both in the clinic and in basic research 19,23,30 and used to noninvasively monitor blood flow, changes in skin thickness, and pathological changes of the skin such as the formation of lesions. 14,50 Our findings of increased skin thickness, and dermal blood flow point to increased vascular permeability and vasodilatation in the inflamed skin of mice with ICD or ACD. Assessments of the severity of cutaneous inflammation obtained by clinical scoring, ultrasound, histology, and measurement of skin thickness revealed the presence of edema, swelling, disruption of epidermal structures, and strong infiltration of immune cells in ACD.…”

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

“…However, in rare cases, the patients may present with delayed allergic reactions with similar symptoms days or months after the sting, even without having experienced an immediate reaction. While a toxic mechanism is held accountable for the immediate reaction, the delayed eruptions are immune-mediated [ 83 , 90 ]. Delayed cutaneous reactions can take multiple presentations, such as keloid-like plaques [ 71 ], nodular and papular eruptions [ 84 , 85 , 139 , 176 ], linear pigmentation [ 86 ], vesicles [ 177 ], and granulomatous infiltration [ 87 ].…”

“…The Doppler mode revealed hypovascularization, which could be attributed to vasoconstriction caused by jellyfish stings. Color or power Doppler imaging is essential for ruling out vascular contraction diseases that could lead to ischemia, namely severe vasospasm caused by jellyfish envenomation [ 83 ].…”

“…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]…”

The Dermatological Effects of Box Jellyfish Envenomation in Stinging Victims in Thailand: Underestimated Severity

“…[11][12][13][14] Jellyfish stings frequently cause immediate local skin reactions; however, although rare, envenomation can cause a delayed allergic reaction. [6][7][8]13,[15][16][17] A case of recurrent dermatitis was reported as lasting over a year after stings had been reported. 15 Other local pathologies that were reported after victims were in jellyfish contact lasted for a few minutes to several weeks and included linear plates, vesicles, papular vesicles, blebs, blisters, widespread papulonodular eruption, pruriginous rash, recurrent dermatitis, dermal hypersensitivity, urticaria, gangrene, and vasospasm.…”