CASE REPORT.

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From: Journal of Family Practice(Vol. 71, Issue 3)
Publisher: Jobson Medical Information LLC
Document Type: Case study
Length: 1,271 words
Lexile Measure: 1720L

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> THE PATIENT

61-year-old woman

> SIGNS a SYMPTOMS

--Nausea

--Paresthesia

--Cold allodynia

> THE CASE

An active 61-year-old woman (140 lbs) in good health became ill during a sailing holiday in the Virgin Islands. During the trip, she ate various fish in local restaurants; after one lunch, she developed nausea, diarrhea, dizziness, headache, and light-headedness. In the following days, she suffered "intense itching" in the ears, dizziness, malaise, a "fluttering feeling" throughout her body, genitourinary sensitivity, and a "rhythmic buzzing sensation near the rectum."

She said that cold objects and beverages felt uncomfortably hot (cold allodynia). She noted heightened senses of smell and taste, as well as paresthesia down her spine, and described feeling "moody." She reduced her workload, took many days off from work, and ceased consuming meat and alcohol because these items seemed to aggravate her symptoms.

The paresthesia persisted, and she consulted her family physician one month later. Laboratory tests--including a complete blood count, hematocrit, thyroid-stimulating hormone, antinuclear antibodies, and titers for Ehrlichia chaffeensis, Lyme disease, and Anaplasma phagocytophiia--all yielded normal results. Her symptoms continued for 3 more months before referral to Medical Toxicology.

THE DIAGNOSIS

The patient's symptoms and history were consistent with ciguatera poisoning. Features supporting this diagnosis included an acute gastrointestinal illness after eating fish caught in tropical waters and subsequent persistent paresthesia, including cold allodynia. (1) Laboratory testing excluded acute infection, anemia, thyroid dysfunction, vitamin B12 deficiency, lupus, rheumatoid arthritis, Lyme disease, ehrlichiosis, and anaplasmosis.

DISCUSSION

Ciguatera results from ciguatoxin, a class of heat-stable polycyclic toxins produced in warm tropical waters by microscopic dinoflagellates (most often Gambierdiscus toxicus). (2,3) Small variations exist in the Caribbean, Pacific, and Indian Ocean forms. Ciguatoxin bio-accumulates in the food chain, and humans most often ingest it by eating larger fish (typically barracuda, snapper, grouper, or amberjack). (4) Because ciguatoxin confers no characteristic taste or smell to the fish, people who prepare or eat...

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Gale Document Number: GALE|A702237904