1 Letter to the Editor Venomous Aquarium Fish Stings Hossein Sanaei-Zadeh 1* 1. Division of Medical Toxicology, Department of Emergency Medicine, Hazrat-e Ali Asghar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. * Corresponding Author: Hossein Sanaei-Zadeh, Professor. Address: Division of Medical Toxicology, Department of Emergency Medicine, Hazrat-e Ali Asghar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: sanaeizadeh@sums.ac.ir Citation: Sanaei-Zadeh H. Venomous Aquarium Fish Stings. International Journal of Medical Toxicology and Forensic Medi- cine. 2024; 14(3):E45372. https://doi.org/10.32598/ijmtfm.v14i3.45372 Use your device to scan and read the arcle online Copyright © 2024 The Author(s); This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC: https://creativecommons.org/licenses/by-nc/4.0/legalcode.en), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Dear Editor espite the rarity of venomous aquarium fish stings, physicians sometimes encoun- ter them. Therefore, it is essential to be fa- miliar with these stings’ clinical effects and know how to approach and treat them. I searched through PubMed, PubMed Central, Scopus, and Google Scholar and found only a few case reports on this subject. To the best of my knowledge, no published articles review or present case series about all venomous aquarium fish, explain- ing their stings’ clinical manifestations and management. As you know, some aquarium fish, such as piranhas and snakeheads, are not venomous, but they may bite the fin- ger or hand [1]. The spiny fins of some aquarium fish such as the Pakistani squint (also known as the comman- do) can cause intense pain and possible infection if they penetrate the skin [1]. This letter explains the clinical ef- fects and management of envenomation by six venom- ous aquarium fish that exist in Iran. The sting of these fish may occur during the cleaning of the aquarium tank or holding the fish. These fish inject venom through their spines. 1) Scat fish (Scatophagus argus): It has three types, sil- ver, green, and red (Figure 1). These fish have dorsal and ventral rough spines, which are venomous. The most common clinical effect of their sting is severe local pain, which may include radiating pain. Erythema and swelling are usually present. In addi- tion, itching, partial paralysis and paresthesia have been reported [2, 3]. 2) Fossil catfish (Heteropneustes fossilis): The pectoral spines of these fish are venomous (Figure 2). Stinging can cause severe pain, swelling and erythema. Further- more, local paresthesia and confusion have been report- ed [4-6]. 3) Common walking catfish (African catfish, Clarias catfish): The dorsal and anal spines of this fish are ven- omous (Figure 3). Sting is associated with severe to moderate pain, swell- ing, and erythema. Reports have indicated tachycardia, muscle weakness, hypotension, paralysis, and long-last- ing paresthesia, even for 24 hours [6]. 4) Striped catfish (Plotosus lineatus): The first dorsal spine and all the pectoral spines of these fish are venom- ous (Figure 4). The signs and symptoms of their sting are similar to those caused by fossil catfish stings, i.e. severe pain, swelling, erythema, and paresthesia. Systemic signs, in- D July 2024, Volume 14, Number 3