From sting to chronic wound - an uncommon weever fish envenomation case involving the knee.

Abstract

Introduction: Weever fish (Trachinus draco) envenomation is one of the most frequently encountered marine injuries in the Mediterranean and coastal European regions. These fish, which possess venomous dorsal and opercular spines, often inflict injuries when accidentally stepped on in shallow waters. While the most common sting sites are the feet and lower extremities, unusual anatomical locations may occasionally be affected. The venom contains thermo-labile proteins, such as dracotoxin, which induce acute pain, inflammation, and potentially localized tissue necrosis.

Case presentation: We present the case of a 55-year-old male who developed a painful lesion on the medial aspect of the proximal left leg after being stung by a weever fish while fishing from a boat. Initially, he experienced severe pain, burning, and swelling. The patient rinsed the area with seawater without attempting to remove the spine. Conservative wound care was initiated at a local facility, which included the administration of antibiotics and analgesics. Over three months, the injury site progressed into a non-healing wound. By the end of the third month, the patient was admitted to our department. There was a yellow necrotic lesion measuring 3.5 × 1.3 cm without any signs of systemic infection or deep tissue involvement. The wound was treated with regular local care and ultimately entirely healed by the sixth month, without the need for surgical debridement or systemic antibiotics.

Conclusions: This case highlights an unusual presentation of weever fish envenomation involving the medial aspect of the proximal left leg - a rare anatomical site. While hot water immersion remains the cornerstone of treatment, favorable outcomes may still be achieved through alternative symptomatic and wound care strategies in mild cases. Health professionals should remain vigilant for potential secondary infection and transformation into a chronic non-healing wound, especially when initial management is delayed or incomplete. Comprehensive wound assessment, patient education, and individualized treatment planning are essential to optimize recovery in marine envenomation cases.