Skin whiplash and ECG changes post jellyfish-encounter: a case report

Background: Only a few articles reported severe cardiovascular events such as myocardial infarction or cardiac failure related to jellyfish stings in humans. This case study aims to evaluate the skin whiplash and ECG changes post jellyfish encounter. Case Presentation: A 61-year-old female presented with pain and tenderness in her right arm, palpitation, and diarrhea. On physical examination, we noted multiple bullae that formed a "whip-like pattern" on the right arm. Admission ECG showed diffuse T wave inversion at precordial leads. On the second day, the ECG showed inverted T waves on all precordial & extremities leads, premature atrial complexes, and prolonged QTc interval (564ms). Laboratory showed elevated Troponin T, fibrinogen, D-dimer, and prothrombin time. The patient was diagnosed with jellyfish envenomation with cardiac injury. Oral zinc gluconate, potassium, and magnesium were given. On the eighth day, the ECG showed inverted T waves were localized to V2-V4, and the QTc interval was back to normal at 409 ms. Conclusion: Although the severe cardiovascular manifestation of jellyfish envenomation is rare, it should be anticipated. A routine ECG should be performed; if abnormal, it should be followed by troponin evaluation. Echocardiography may be performed if appropriate. Antiarrhythmic medications should only be used in case of malignant ventricular arrhythmia.