The lionfish (Pterois volitans) belongs to the group of venomous Scorpaenidae and their natural habitat is restricted to the tropical regions of the world, primarily the Caribbean Sea and Central America [1]. However, studies have confirmed their presence throughout the Atlantic Ocean, resulting in the increased risk for lionfish stings in South America and the United States, in addition to the Caribbean countries [2]. Lionfish sting is considered to be a rare occurrence in clinical practice and activities that increase the risk include fishing, diving, or swimming in the mentioned areas [1] [2]. Some reports have documented stings from lionfish kept in aquariums as well [3]. The pathogenesis of a lionfish sting stems from the neurotoxic venom that is released by the fish during direct contact [4]. Patients almost always present with symptoms involving a single extremity (upper much more commonly than lower) [2] [5], and most common signs are erythema and extensive edema accompanied by pain that is described as quite severe, whereas paresthesias, abdominal cramping, local heat, cyanosis, and blistering of the skin are frequent findings as well [1] [2] [4] [5]. Cardiovascular symptoms, such as hypotension and tachycardia, are seen in a subset of patients, while hyperthermia, development of a localized infection, and transient weakness are less common findings [2] [4] [5] Although the clinical course typically ends with a good recovery without significant sequelae, limb paralysis, anaphylaxis, and heart failure have been reported [2] [4] [5].

• Severe Pain

  Not only do treatment facilities have access to some really nifty pain medications that you WILL want, there can be other complications that aren’t immediately apparent, too: Severe pain can cause shock which may involves shortness of breath, weakness [lionfish.co]

  Following envenoming the affected individual presents with Immediate severe pain at the sting site Local swelling, bruising and puncture marks. [lifeinthefastlane.com]

  Signs and symptoms Severe pain Redness, bruising, swelling Treatment Prevention is the best treatment. Stay aware of your surroundings and remember lionfish can sting after they are dead. [tdisdi.com]

  The venom is composed of acetylcholine and a neurotoxin which causes severe pain, swelling and rash in humans. Tim Codling, avid diver and lionfish culler was recently stung while removing a lion fish from the cobalt blue waters of Grand Cayman. [idivecayman.com]

  The primary symptom of stonefish envenomation is burning, severe pain, which soon begins to spread up the limb. In addition, serious swelling begins shortly after the sting. [dengarden.com]

• Localized Pain

  In a series of 101 documented cases of captive lionfish envenomations in the US, the following effects were reported (Gallagher, 2001): 92% of patients experienced local pain 60% of patients experienced edema 13% of patients experienced systematic symptoms [reefkeeping.com]

  Judging from this and other reports in the United States, the vast majority of lionfish stings appear to result in uncomplicated wounds with severe local pain that is responsive to immersion therapy. [emedicine.medscape.com]

  For example, in a series of 101 documented cases of captive lionfish envenomations here in the United States, the following effects were reported by Gallagher (2001): 92 percent of patients experienced local pain, 60 percent of patients experienced swelling [tfhmagazine.com]

  The pain can can last for days, or even weeks, and increase in intensity as time goes on. Victims of Irukandji Syndrome experience a reaction to the venom that is much worse than localized pain originating at the site of the sting. [dengarden.com]

• Localized Edema

  Lionfish sting is notable for its severe clinical presentation in the form of erythema, paresthesias, profound localized edema, and abdominal cramping. Systemic symptoms are rare. [symptoma.com]

• Nausea

  In worst case scenarios the symptoms may include headache, nausea, abdominal pain, delirium, seizures, paralysis of limbs, changes in blood pressure, breathing difficulties, heart failure and tremors, pulmonary edema, and loss of consciousness. [hawaiiscubaadventures.com]

  Colliding with a lionfish's toxic sting is likely to cause nausea and vomiting. You may feel feverish with headaches and dizziness. It is also common to suffer breathing difficulties from lionfish stings. [private-scuba.com]

  Redness, bruising, swelling, numbness, tingling, and tissue shedding at the wound site Severe reactions include: Nausea Vomiting Abdominal cramps Tremors Abnormal heart rhythms Weakness Shortness of breath Seizures Decreased blood pressure Fainting Paralysis [webmd.com]

  On rare occasions, when the venom spreads to other parts of the body, people may experience headaches, chills, cramps, nausea, and even paralysis and seizures. [oceanservice.noaa.gov]

  Severe reactions include nausea, vomiting, abdominal cramps, tremors, abnormal heart rhythms, weakness, headache, diarrhea, slow heart rate (bradycardia), shortness of breath, seizures, decreased blood pressure, fainting, and paralysis. [emedicinehealth.com]

• Vomiting

  If the injured person appears intoxicated or is weak, vomiting, short of breath or unconscious, seek immediate advanced medical care. [blog.daneurope.org]

  Colliding with a lionfish's toxic sting is likely to cause nausea and vomiting. You may feel feverish with headaches and dizziness. It is also common to suffer breathing difficulties from lionfish stings. [private-scuba.com]

  Redness, bruising, swelling, numbness, tingling, and tissue shedding at the wound site Severe reactions include: Nausea Vomiting Abdominal cramps Tremors Abnormal heart rhythms Weakness Shortness of breath Seizures Decreased blood pressure Fainting Paralysis [webmd.com]

  Although fatalities are rare, the stings can cause extreme pain, vomiting and respiratory paralysis. [independent.co.uk]

  In humans, lionfish venom can cause systemic effects such as vomiting, fever and sweating. In some cases, it has been lethal. The effect of the venom weakens the force of muscular contractions), and increases the heart rate. [turtlebaydiveresort.com]

• Abdominal Cramps

  Lionfish sting is notable for its severe clinical presentation in the form of erythema, paresthesias, profound localized edema, and abdominal cramping. Systemic symptoms are rare. [symptoma.com]

  Redness, bruising, swelling, numbness, tingling, and tissue shedding at the wound site Severe reactions include: Nausea Vomiting Abdominal cramps Tremors Abnormal heart rhythms Weakness Shortness of breath Seizures Decreased blood pressure Fainting Paralysis [webmd.com]

  Severe reactions include nausea, vomiting, abdominal cramps, tremors, abnormal heart rhythms, weakness, headache, diarrhea, slow heart rate (bradycardia), shortness of breath, seizures, decreased blood pressure, fainting, and paralysis. [emedicinehealth.com]

• Abdominal Pain

  In worst case scenarios the symptoms may include headache, nausea, abdominal pain, delirium, seizures, paralysis of limbs, changes in blood pressure, breathing difficulties, heart failure and tremors, pulmonary edema, and loss of consciousness. [hawaiiscubaadventures.com]

  Worst case scenarios, though not normally fatal to humans, include headache, nausea, abdominal pain, delirium, seizures, paralysis of limbs, changes in blood pressure, breathing difficulties, heart failure and tremours, pulmonary edema, and loss of consciousness [dive-the-world.com]

• Cyanosis

  […] present with symptoms involving a single extremity (upper much more commonly than lower), and most common signs are erythema and extensive edema accompanied by pain that is described as quite severe, whereas paresthesias, abdominal cramping, local heat, cyanosis [symptoma.com]

  Cardiovascular signs such as hypotension, bradycardia, collapse, pulmonary oedema and cyanosis are rarely reported. Differential diagnosis Other fish stings Stingray injury. [lifeinthefastlane.com]

• Myalgia

  […] infusion Give oxygen, IV fluids and administer IM adrenaline 0.01 mg/kg(max 0.5 mg) to lateral thigh Serum sickness This relatively benign and self limiting complication may occur 5–10 days after antivenom Manifestations include fever, rash, arthralgia and myalgia [lifeinthefastlane.com]

Because of the fact that lionfish stings are rather easily treated by immersing the affected extremity in hot water (due to the heat-labile properties of the neurotoxin) [4] [5], early recognition of this clinical entity can lead to prompt and effective therapy. For this reason, the physician's role in obtaining a detailed patient history is vital. Previous activities and confirmation of a lionfish sting by the patient is perhaps the most important piece of information needed to make the diagnosis. A full physical examination should follow, during which a complete inspection, as well as palpation of the affected extremity, must be carried out. At the time of admission, lionfish stings may present as erythema, blistering, or dermal necrosis [1] [6], depending on the duration of symptoms before the examination. Moreover, typical symptoms can be completely absent in the case of an "empty sting", ie. no venom was released from the lionfish [3]. Although isolated reports document several abnormalities during biochemical workup in a small number of patients (hypophosphatemia, elevated liver enzymes, thrombocytopenia) [5], the diagnosis primarily rests on clinical criteria supported by findings revealed during history.

Administration of analgesia ( never use aspirin in conjunction with hot water treatments ). Watch for signs of systemic symptoms and be ready to perform CPR if necessary or treatment for anaphylactic shock. [hawaiiscubaadventures.com]

Signs and symptoms Severe pain Redness, bruising, swelling Treatment Prevention is the best treatment. Stay aware of your surroundings and remember lionfish can sting after they are dead. [tdisdi.com]

Mary’s Medical Center for treatment. Fire Rescue officials said the hospital has a hyperbaric chamber that can be used for treatment. [wptv.com]

The shtick that's earned him fame is that he allows various animals to bite or sting him, and then he describes the pain he endures and the treatment for it. [wideopenspaces.com]

Prognosis The severity of Scorpaenidae envenomations is progressively worse from Pterois to Scorpaena to Synanceia species. [emedicine.medscape.com]

(Etiology) Lionfish Stings release a poisonous chemical into the human skin through their spine, which can affect the human body Depending on the amount of poison injected, the severity of the signs and symptoms is dictated What are the Signs and Symptoms [dovemed.com]

Epidemiology United States The true number of Scorpaenidae envenomations is unknown. [emedicine.medscape.com]

Pathophysiology Common to the family Scorpaenidae are 12-13 dorsal spines, two pelvic spines, and three anal spines. Each spine is associated with a pair of venom glands. A loose integumentary sheath covers each spine. [emedicine.medscape.com]

Prevention is key, the best solution is to wear puncture resistant gloves and take great care in handling the lionfish. Not all of the lionfish spines carry the venom. [lionfishhunting.com]

Signs and symptoms Severe pain Redness, bruising, swelling Treatment Prevention is the best treatment. Stay aware of your surroundings and remember lionfish can sting after they are dead. [tdisdi.com]

Remaining spine fragments should be removed from the skin by a Doctor to prevent infection. The medical professional may also administer a painkiller because lionfish stings are painful and you can expect several days of discomfort. [private-scuba.com]

Photo Courtsey of Shutterstock First Aid Essentials after a Lionfish Sting First aid is essential in preventing infections; clean the wound, control the pain and apply topical antibiotics using these easy-to-follow steps: Wash the area thoroughly with [scubadiving.com]

1. Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016;16:ic20.
2. Resiere D, Cerland L, De Haro L, et al. Envenomation by the invasive Pterois volitans species (lionfish) in the French West Indies—a two year prospective study in Martinique. Clin Toxicol (Phila) 2016;9:1–6.
3. Haddad V, Stolf HO, Risk JY, Franca FOS, Cardoso JLC. Report of 15 injuries caused by lionfish (Pterois volitans) in aquarists in Brazil: a critical assessment of the severity of envenomations. J Venom Anim Toxins Incl Trop Dis. 2015;21:8.
4. Satora L. Lionfish envenomations in Poland. Przegl Lek. 2009;66(6):285-286.
5. Diaz JH. Marine Scorpaenidae Envenomation in Travelers: Epidemiology, Management, and Prevention. J Travel Med. 2015;22(4):251-258.
6. Patel MR, Wells S. Lionfish envenomation of the hand. J Hand Surg Am. 1993;18:523 – 525.