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Fulminant Hepatic Failure from a Sea Anemone Sting
- Patricia J. Garcia, MD;
- Roland M. H. Schein, MD; and
- Joseph W. Burnett, MD
- From the University of Miami School of Medicine and the Department of Veterans Affairs Medical Center, Miami, Florida, and the University of Maryland School of Medicine, Baltimore, Maryland. Requests for Reprints: Patricia J. Garcia, MD, Department of Veterans Affairs Medical Center, Medical Service RF 111, N.W. 16th Street, Miami, FL 33125. Acknowledgments: The authors thank Dr. George Hensley for preparation of pathology specimens, Dr. Eugene Schiff for review of the manuscript, and Mrs. Jan Kampka and the Medical Media staff for technical assistance in the preparation of the manuscript.
Coelenterate stings can produce various local and systemic reactions. We report the first known case of fulminant hepatic failure attributable to a sea anemone sting. The patient, who developed hepatic failure within 3 days of envenomation, had negative hepatitis serologic tests and no other potential hepatotoxin exposure. A biopsy of the liver showed massive hepatic necrosis. The patient's serum tested positive for IgG by enzyme-linked immunosorbent assay (ELISA) against Condylactis sp. antigen at a dilution of 1:450. We retrospectively tested serum from another man who had had transient elevations of liver function levels after a presumed coelenterate sting, and the titers to Condylactis sp. antigen were identically elevated.
Case Report
A 28-year-old, previously healthy white man was transferred to Jackson Memorial Hospital in Miami, Florida, from St. Thomas, Virgin Islands, because of hepatic failure complicated by coma, severe coagulopathy, and acute renal failure. He had no history of alcohol or drug abuse or previous abnormal reaction to stings. The patient had sustained a sting from a sea anemone on the left scapula while free diving at 6 to 10 meters. Ten to 15 minutes after contact, he developed a vesicular eruption and severe pain in the back and arms. When he arrived at a local hospital approximately 30 minutes after the sting, he was alert …
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