Hemorrhagic Blisters, Necrosis, and Cutaneous Ulcer after Envenomation by the Niquim Toadfish

• Published in: The American journal of tropical medicine and hygiene Vol. 101; no. 3; pp. 476 - 477
• Main Authors: Haddad, Vidal, Lopes-Ferreira, Mônica, Mendes, Adriana Lúcia
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01.09.2019; The American Society of Tropical Medicine and Hygiene
• Subjects: Adult; Animals; Batrachoidiformes; Bites and Stings - diagnosis; Blister - etiology; Female; Fish Venoms; Humans; Images in Clinical Tropical Medicine; Necrosis - etiology; Skin Ulcer - etiology; Ulcers
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.19-0321

Toadfishes are found in tropical, marine, and estuarine waters. They have a highly developed venomous apparatus with dorsal and preopercular spines. Envenomation by this species can cause local inflammatory manifestations such as pain, edema, and erythema that can progress to cutaneous necrosis. A 38-year-old woman stepped on something in a lagoon among the stones of a beach in Bahia state, Brazil. She then noticed two small perforations in the third toe of the right foot with slight bleeding. The place began to ache unbearably and she was medicated with painkillers. After 3 days, intense inflammation and hemorrhagic blisters appeared near to the perforations. In about 10 days, the upper blister delimited a necrosis and the formation of an ulcer covered by hematomeliceric crust. The pain, which had persisted for about a week, had disappeared. One month later, ulcer was healed, leaving a scar. Wounds by venomous fishes can be difficult to identify. Catfishes and stingrays cause mainly unique perforations, but the envenomation by toadfishes causes a characteristic double perforation by the dorsal spicules.