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Multiple slightly hyperkeratotic nodular swellings with central hypopigmentation on the dorsum of the patient's hands.
Source publication
Penetrating wounds from sea urchin spines are marine injuries that may cause morbidity in humans. Seasonal fishing for abalone in Dhofar is associated with an increase in the number of these injuries, as divers may strike their extremities, especially the dorsum of hands and fingers, on the rocks where Echinoderms and juvenile abalone (Haliotis mar...
Context in source publication
Context 1
... examination of dorsum of hands revealed 11 nodular swellings. They were brown, 3-5 mm in diameter, non-tender, firm in consistency, and slightly hyperkeratotic with central hypopigmentation [ Figure 1]. Both hand joints examination showed nonpainful, normal range of active and passive motions. ...
Citations
... There is a plethora of information on treatments for these puncture injuries, with the most common among medical professionals being the removal of all partially embedded spines and the removal of as many fully embedded spines as possible. Urban legend, local surfing cultures, and even some published literature, though limited, share the common perspective that sea urchin spines left in place in the soft tissue beneath the epidermis will gradually be extruded, dissolve, or be absorbed by the surrounding tissue [2,3,10,22,24,25]. The main finding of the persistence of the larger spine fragment in the soft tissue of our patient's foot is not consistent with this hypothesis. ...
... Due to their chemical composition, sea urchin spines are radiopaque and visible on plain radiographs, making this the preferred technique for visualizing the presence of sea urchin material [10,26]. There are reports, however, where embedded spines were not visible on plain radiographs [5,22,24,27]. Nassab and coworkers [5] propose that a delay in the presentation of an embedded sea urchin spine to medical facilities where radiographs can be performed "may result in failure to show the spines radiographically as the surrounding tissues absorb the calcium [28]." Their reference to the case report of Newmeyer [28] is problematic. ...
When sea urchin puncture injuries occur during coastal recreation or work activities, they often affect extremities, such as hands and feet. There is a plethora of information on treatments for these puncture injuries, with the most common among medical professionals being the removal of all partially embedded spines and the removal of as many fully embedded spines as possible. When the spines are deeply embedded and/or fragmented, they might not be removed, especially when they are not located in critical areas such as tendons or joints. This reflects the generally held notion that smaller spines and spine fragments will eventually dissolve or be absorbed. Here we report an unusual case where the tip of a sea urchin spine became embedded in the soft tissue of the sole of the foot of a 21-year-old male after he stepped on one after falling off a kayak off the coast of Oahu, Hawai’i. The deeply embedded spine was not removed. By three weeks after the injury, the patient did not have any symptoms, and eight years later, he was still symptom-free. Radiographs taken one year after the injury showed that the spine had fragmented into two pieces. The smaller piece was about 15% of the size of the original embedded spine, and it had apparently been absorbed (it was not seen on final radiographs eight years later). Analysis of radiographs eight years after the injury showed that the main or large spine fragment was still distinctly detectable in the soft tissue; there was no visible evidence that it had undergone significant absorption or migrated from the original location. The absence of any obvious radiographic rarefaction over eight years is contrary to the lore that sea urchin spines that remain in human soft tissue will exhibit significant, or complete, absorption or dissolution over months to a few years.
... Fremdkörperreaktionen treten am häufigsten nach Injektion verschiedener Medikamente, nach direkter Gelenkverletzung durch Traumata oder nach Gelenkopera-tioneneinschließlichGelenkersatztherapie auf. Eine seltene granulomatöse Entzün-dung im Rahmen einer Fremdkörperreaktion stellt die Seeigelstachelsynovialitis dar [5]. ...
The investigation of alterations to synovial tissue can contribute to the diagnosis of joint and systemic diseases. The domain of histological diagnostics is important to differentiate tumorous and inflammatory conditions. Moreover, crystal arthropathies and certain metabolic diseases can be identified. The histological picture of granulomatous synovitis can be caused by a mycobacterial infection, sarcoidosis and foreign body reactions as well as rare genetic diseases. Furthermore, subtyping of amyloidosis is possible in the tunica synovialis. Molecular methods enable reliable and rapid diagnostics of septic arthritis and a subtyping of microorganisms. Additionally, reactive arthritis can also be classified by the identification of DNA or RNA of microorganisms in joint tissue or fluid. The diagnosis of rheumatoid arthritis is based on the American College of Rheumatology (ACR) criteria. Molecular methods, such as micro-RNA technology or proteomics methods can assist in the diagnosis of rheumatoid arthritis.
In the UK, sea urchin‐related injuries (SUI) most commonly present in returning travellers. Delayed complications mainly impact skin but nerves, tendons, joints and bones may be affected. Management of chronic reactions may be challenging and a variety of approaches have been described. Surgical measures are often undertaken, particularly when retained spines are suspected. We demonstrate through three cases presenting in the UK with chronic SUI, that conservative management, surgery and intralesional corticosteroids may all be associated with satisfactory outcomes. Management options should consider the presence of retained spines, injury site, symptoms, and importantly, patient preference.
