1106 A Walk on the Beach May Become What the Doctor Recommends

Abstract Introduction Severe refractory restless leg syndrome (RLS) can be quite disabling, affecting quality of life and sleep. Current treatment modalities include iron supplementation, dopamine agonists, alpha-2 delta ligands and opioids. Patients who have wrestled with these symptoms for years have typically exhausted all the known therapeutic modalities. We present a rare case where a patient experienced some relief from a most unusual source. Report of Case A 69-year-old male had prolonged and documented history of severe RLS, refractory to established treatment modalities. His medical history, family history, and physical examination were unremarkable. A low ferritin level was discovered but appropriately treated. While his fight for RLS continued, he encountered a jellyfish while swimming off the coast of southeastern US and was stung on his calf. He experienced burning pain with redness on his calf, followed by the resolution of his RLS symptoms. The effect lasted 2 weeks and his RLS recurred. Several months later, he acquired a jellyfish and stung himself again. Again his RLS improved for another few weeks. At this time he was not taking RLS medications. Thereafter, RLS symptom recurred. The jellyfish was identified to be a Cannonball species (Stomolophus meleagris). Conclusion Cannonball Jellyfish inhabit the southeastern coast of the US. They can secrete toxic mucus. Although they do not commonly attack humans, there are reports of the toxin affecting myocardial conduction pathways. In animal models the major effects appear to be dermonecrotic, hemolytic, and cardiovascular. One report suggested the toxin potentially altering the ionic permeability of the sarcolemma membrane of skeletal muscle. While it is a novel discovery that this jellyfish toxin worked as a temporary cure for our patient’s RLS, the mechanism is unclear. Further research with this phenomenon on potential treatment for refractory RLS will be very interesting.