A 37-year-old man was wading in the ocean when he felt a sudden sharp pain in his right foot. Upon exiting the water, he noticed a small pointed object embedded in his foot, and the skin around the wound appeared mottled. He experienced excruciating throbbing pain that eased when he soaked his foot in hot water but returned when removed. The next day the pain was nearly gone, though a tender swelling developed in his right groin over the next week. He recovered without medical treatment. Stingrays are common in coastal US waters and possess a sharp spine on their tails, which can cause painful envenomations if stepped on, as occurred in this case.

1. doi:10.1016/j.jemermed.2005.02.024
Visual Diagnosis
in Emergency Medicine
STINGRAY ENVENOMATION
Matthew D. Cook, DO,* Michael J. Matteucci, MD,* Rohan Lall, MD,† and Binh T. Ly, MD*
*Department of Emergency Medicine and †Department of Surgery, University of California, San Diego, California
Reprint Address: Matthew D. Cook, DO, Department of Emergency Medicine, Division of Medical Toxicology, UCSD Medical Center,
200 West Arbor Drive, San Diego, CA 92103-8925
CASE REPORT
A 37-year-old man was wading in the shallow ocean
water of a Southern California beach when he felt a
sudden sharp pain in his right foot. Upon exiting the
water, he noticed a small pointed object embedded in the
sole of his foot (Figures 1 and 2). The skin around the
wound appeared mottled (Figure 1). He began to expe-
rience excruciating, throbbing pain in the foot to the
point of near-syncope. On the advice of the beach life-
guard he immediately returned home and submerged his
foot in a bathtub of hot water. This greatly relieved his
pain, but upon removing his foot from the water the pain
returned. After several hours of soaking his foot he was
able to tolerate the pain out of the hot water with oral
analgesics. By the next day he was nearly pain free. He
developed a tender swelling in the right groin over the
next week, but recovered uneventfully, never seeking
professional medical care.
DISCUSSION
The coastal waters of the United States are home to 22
species of stingray (1). These are cartilaginous fish of the
same class as sharks (Elasmobranchii) (1,2). The Urolo-
phidae (round stingrays) and Dasyatidae (whiprays) pre-
dominate the temperate waters of the West and South-
eastern U.S. coasts, respectively (1,3). These wide, flat
fish propel themselves through the water with their wing-
like pectoral fins. Stingrays also possess one or more
sharp spines at the base of a whip-like tail. These spines
This article was co-written by LCDR Michael J. Matteucci,
MC, USNR, while a Fellow at UCSD Medical Center training
in Medical Toxicology. The views expressed in the correspon-
dence are those of the authors and do not reflect the official
policy or position of the Department of the Navy, Department
of Defense, nor the United States Government.
Visual Diagnosis in Emergency Medicine is coordinated by Binh Ly, MD, of the University of California San Diego
Medical Center, San Diego, California
RECEIVED: 3 December 2005;
ACCEPTED: 7 February 2005
Figure 1. Stingray spine immediately after removal from foot.
Note jagged laceration (arrow) and mottled appearance of
skin surrounding wound (outlined).
The Journal of Emergency Medicine, Vol. 30, No. 3, pp. 345–347, 2006
Copyright © 2006 Elsevier Inc.
Printed in the USA. All rights reserved
0736-4679/06 $–see front matter
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