Disclosures: Evan R. Zeldin, MD: No financial relationships or conflicts of interest

Case Diagnosis: Multiple patients with delayed wound healing from stingray attacks

Case Description: This case series consists of 3 patients, a 90-year-old male, a 61-year-old female, and a 46-year-old male who were stung in the lower extremity by a sting ray. All patients were treated with antibiotics prior to their visits to the wound care center and presented 2 weeks to 2 months after the initial injury.

Setting: Outpatient academic wound healing centerAssessment/

Results: Two patients’ wounds had the fat pad exposed, the third developed osteomyelitis of the underlying bone. The wounds required excisional debridement and were dressed with a silver-calcium alginate dressing as well as further antibiotic therapy. Two patients experienced complete wound healing, the third was non-compliant with treatment and lost to follow-up.

Discussion: Approximately 750 to 2000 injuries occur each year in the United States due to stingrays. Stingrays are generally not aggressive, however, when provoked, may sting with their tail containing barbed spines. Injuries commonly occur when an individual steps on the stingray in murky water, resulting largely in lower extremity injuries. Complications result from retained fragments of the stingray spine, bacterial infections from brackish water or the stingray itself, or stingray venom causing local or systemic effects. Hot water immersion can inactivate the venom. These wounds can become necrotic and lead to delayed wound healing. Treatment involves debridement, antimicrobial dressings such as silver-calcium alginate, and systemic therapy with oral or intravenous antibiotics depending on type of water exposure and extent of infection, such as clindamycin and doxycycline, especially if there is concern for Vibrio species. Physicians should ensure patients are current on tetanus vaccinations.

Conclusion: Stingray injuries can result in wounds with delayed healing. They should be treated aggressively with empiric antibiotics and if necessary excisional debridement and antimicrobial dressings. Patients benefit from referral to wound healing centers for regular monitoring and treatment.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-stingrays-attack-three-patients-with-delayed-wound-healing-after-being-stung-by-a-stingray-a-case-series/