Irukandji-Like Syndrome in the Caribbean Sea, Puerto Rico: Case Report

Abstract

Irukandji syndrome has been described as a painful envenoming event caused by different species of jellyfish, mainly in the Cubozoa class. This hypercatecholaminergic condition, with recorded fatalities and severe systemic symptoms, has been described mostly on Australian seas. To our knowledge, Irukandji syndrome has not been reported in Puerto Rico or the Caribbean Sea. Our report describes 2 cases of marine envenomation causing this syndrome in Puerto Rican divers. The aim of this case report is to raise awareness of this syndrome in the Caribbean area, thus preventing misdiagnosis, underreporting, and improper treatment strategies. A 40-year-old man was diving east of Puerto Rico island. After the ascend, he was struck by a box-shaped jellyfish, clear to light blue in color, with long tentacles. The diver then had lower limb weakness, severe back pain, fast heart rate, palpitations, agitation, memory impairment, disorientation, nausea, shortness of breath, diaphoresis, involuntary tremors, and an intense feeling of doom. Hyperbaric treatment was given but was unsuccessful. The Poison Control Center of Puerto Rico made the diagnosis of Irukandji-like syndrome. The Irunkandji syndrome can be a life-threatening condition if it is treated incorrectly or is misdiagnosed, as could happen if it occurs outside the usual areas. In the Caribbean area, we should be more aware of this syndrome and include it in the differential diagnosis when a patient comes to us with hypercholinergic symptomatology.