Blow: a case of pufferfish intoxication in South Florida

Abstract

We report the case of a 43-year-old African American man with a history of hypertension and chronic kidney disease presenting with hypertensive emergency and bulbar paralysis in a descending fashion, which ultimately led to acute respiratory failure. He ingested pufferfish liver during the preceding 4 hours prior to presentation, as well as canned foods and cocaine over the prior 3 days. He had a complicated hospital course requiring intubation and mechanical ventilation, as well as the development of acute respiratory distress syndrome and acute renal failure requiring haemodialysis. This case exemplifies the classic manifestations of tetrodotoxin poisoning with some unique overlapping features, in the setting of an interesting social history.

Oral Chronic Toxicity of the Safe Tetrodotoxin Dose Proposed by the European Food Safety Authority and Its Additive Effect with Saxitoxin

“…TTX was initially associated mainly with human fatalities occurring in South East Asia [1] but it has been demonstrated to affect also other regions in the Pacific and Mediterranean [2,3]. In fact, a severe case of human intoxication by consumption of pufferfish liver during the preceding 4 h prior to presentation, together with ingestion of canned foods and cocaine during the previous 3 days has been recently reported in Florida [4]. In Europe, the first non-fatal human intoxications by TTX were reported after the ingestion of a Charonia lampas trumpet shellfish captured in the Portuguese coast and purchased in Spain [5].…”

Hybrid Antibody–Aptamer Assay for Detection of Tetrodotoxin in Pufferfish

“…Pufferfish poisoning is typical of warm waters and was regarded as a problem confined to Asian countries, , including Thailand, Taiwan, Singapore, Cambodia, Bangladesh, and India. , However, toxic pufferfish species have expanded to other regions, and there have been an increasing number of reports of incidences in the Mediterranean Sea, which has been attributed to the opening of the Suez Canal (the “Lessepsian migration”), which resulted in the migration of species from the Red Sea to colonize the Mediterranean Sea, − the Aegean Sea, the Adriatic Sea, and Oman, and there have also been reports of the incidence of tetrodotoxin in Australia and the United States, highlighting the widespread distribution of the toxin.…”