This healthy 10-year-old boy was accidentally impaled in the abdomen by a stingray barb a week ago. The area was bathed with warm water to inactivate toxin, and the pain resolved within an hour. He had emergency surgery to remove the barb from his liver and abdomen and treated with broad spectrum parenteral antibiotics including doxycycline to cover for anerobic infection and vibrio organisms. He subsequently developed painless fat necrosis, and 6 days after discharge progressive painless erythema was noted. He was readmitted to the hospital where he received doxycycline, unasyn and vancomycin with rapid resolution of the erythema. He was discharged home on oral doxycyline and conservative wound care.
