Thermal immersion in managing greater weever sting: A case study on delayed recovery

We report the case of a 49-year-old woman who suffered an envenomation from a greater weever during a seaside vacation along the Aegean coast in Izmir, Türkiye. Following the incident, she experienced intense pain and sought treatment at an emergency department, where she received analgesics and cold compresses. Unfortunately, this approach failed to alleviate her pain, which persisted for approximately 24 hours. On the twelfth day, with symptoms worsening and the emergence of a larger wound than the one sustained on the day of the incident, she visited the University Hospital for further care, where she received periodic wound cleaning and a six-week antibiotic treatment regimen for possible osteomyelitis after suspicious findings on her Magnetic Resonance Imaging. The standard treatment for piscine envenomation involves hot water immersion to neutralize thermolabile toxins, providing pain relief and preventing subsequent complications. The water temperature should be between 40 and 45 degrees Celsius, and the affected body part should be immersed for at least 60 minutes. This case underscores the critical nature of hot water immersion in managing envenomation, a step which, if omitted, can result in extended pain duration and the evolution of a wound requiring over five months to heal.