Tropical aquarium aquatic dermatoses: bristle worm envenomation

A 55-year-old high school science teacher with diabetes presented with severe pain and swelling of his left hand. He reported receiving a "shock" 2 days earlier while cleaning out his classroom's aquarium with a bare left hand. Thinking it was a "short" in the electrical connections to the aquarium's pump, he disconnected the electrical cord and continued to clean behind the pump mechanism. After a few more such shocks he put on a glove and retrieved 10 foot-long worms. Antibiotics were started. It took more than 2 weeks for the hand to return to its normal size. On presentation to our office, the patient's left hand was moderately swollen, with blistering and purpura seen on his distal fingers. He reported pain, itching, and numbness in the hand, which was getting worse. No systemic symptoms were reported. The patient was a non-insulin-dependent diabetic who was also taking warfarin for a carotid vascular problem. He brought to our office a bucket with coiled aquatic worms at the bottom (Figure 1). When extended, they measured about 1 foot and their morphology could be better seen (Figure 2). No spicules could be seen in the patient's hand on magnification, but taping was performed to remove any possible residual spicules. The patient was given oral antibiotics, a Medrol dose pack, oral antihistamines, and topical corticosteroids. Within 1 day of starting treatment his symptoms and hand swelling began to abate, by 1 week his hand skin peeled, and by 2 weeks the swelling and skin appearance was almost back to normal. Bacterial cultures of the hand's wounds showed no growth.