Persistierende Hautreaktion und Raynaud-Syndrom nach einem Stich durch den Fisch Echiichthys draco (Peterm�nnchen)

Abstract

A 54-year-old recreational angler was stung in his right forefinger by Echiichthys draco. Within a few seconds he developed severe swelling with extreme pain sensation at the sting site, accompanied by dizziness and chill. Even under morphine therapy the pain symptoms were only slightly reduced. During the subsequent weeks, an erythema with marginate medium-sized scaling developed at the sting site and the patient experienced a approximately 50% reduced bending capacity of the forefinger and permanent numbness in this region. After 4 months, Raynaud phenomenon developed limited to the right forefinger. Great weever fishes (Echiichthys spp.) are the most venomous fishes in European waters. In humans, life-threatening sting reactions occur only in exceptional cases. As a commercial antiserum is not available, the therapy is mainly empiric (General measures of first aid and emergency medicine, the wound should be thoroughly washed). Patients should be informed that reduced motion ability, swelling or Raynaud's phenomenon can persist for several months.

Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management

“…Members of this family present characteristic spines on the opercula and on the first dorsal fin, through which they can inject venom into the body of their attackers/predators ( Figure 4 A) [ 69 ]. A recent work indicates almost 40 patients stung by the weever in Europe [ 70 ], suggesting that Trachinidae is the fish family causing the highest number of envenomations [ 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ].…”

“…The affected area first becomes erythematous, then edematous ( Figure 4 F), and necrosis can ultimately occur. Fever, arthralgia, cardiac arrhythmias and tonic–clonic seizures can also arise [ 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ].…”

“…Inhabiting the sandy bottoms of Atlantic, Pacific and Indian Oceans, members of this family also inhabit the Mediterranean and the Red and Black Seas [ 94 , 95 ]. Stargazer fish are distinguishable for having the eyes located on top of their heads and for possessing two venomous spines, one per gill operculum ( Figure 4 B) [ 68 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 96 , 97 , 98 ]. Despite the presence of several case reports in the web [ 99 ], it should be noted that the actual presence of venom in stargazer fish spines is sometimes still questioned (see [ 100 ]) and that reports concerning envenomations caused by members of the family Uranoscopidae in the official literature appear to be lacking.…”

Weevers (Trachinidae) stings in European seas: Double case report and review of the literature

“…Lymphangitiis and lymphadenopathies may appear, as well as cases of finger amputation and persistent Raynaud's phenomenon have been reported. [5][6][7][8][9][10] Fatalities, although rare, may occur and are usually related to respiratory failure (sero-hemorrhagic fluids and interstitial oedema in the lungs) or sepsis. 4,9 While, although theoretically probable, to date, there are no reported cases of anaphylaxis as a direct result of weever sting.…”

Aquatic dermatoses

“…Later numbness of the involved site can develop. General symptoms such as nausea, sweating attacks, respiratory distress and circulating collapse are rare [9]. Therapy: As no antitoxin is available, treatment is purely symptomatic.…”