Palytoxin poisoning via inhalation in pediatric siblings

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: We report a case of palytoxin inhalational toxicity in pediatric siblings following secondary exposure to vapors from cleaning of an aquarium containing Zoanthids. Symptoms included fever, tachycardia, leukocytosis and elevated lactic dehydrogenase. Both patients received supportive treatment in the pediatric intensive care unit and were discharged after 48 hours. Symptoms also occurred in children's parents including cleaning attendant. Conclusion: Herein, we present a rare case of inhalational toxicity from palytoxin.

Palytoxin-Containing Aquarium Soft Corals as an Emerging Sanitary Problem

“…Another case of poisoning ascribed to inhalational exposure to vapors from soft corals was reported by Sud and co-workers [ 64 ] and subsequently deepened by Rumore and Houst [ 65 ]. It involved five persons: a professional fish tank cleaner, the owner of a fish tank, his wife, and their two children.…”

Coral Keratitis: Case Report and Review of Mechanisms of Action, Clinical Management and Prognosis of Ocular Exposure to Palytoxin

“…3,8,22,23 To our knowledge, there are fourteen published reports of inhalational PTX exposure comprising forty-four cases. 3,9,22,[24][25][26][27][28][29][30][31][32][33] This represents the most reported exposure route in the literature. Of these, nearly all are associated with inhalation of steam or vapor after attempting to clean or remove zoanthid or palythoa from home aquariums with the use of hot or boiling water.…”

“…The presenting symptoms are most commonly dyspnea, 3,9,22,24,25,27,28,[30][31][32] chest pain, 3,22,27 cough, 24,25,27,28,30,32,34 tachycardia, 3,9,24,27,28,30,33 nausea and/or vomiting, 3,27,29,30,33 headaches, 3,30 fever, 9,24,25,[28][29][30][31][32][33] and myalgia or weakness. 9,25,26,28,29,31,32 Since there is no antitoxin for PTX all patients received symptomatic treatment and all recovered within one month with three exceptions (one patient...…”

“…Inhalational exposure can result in dire appearing symptomatology (including an ICU stay in our patient), but with appropriate supportive care, nearly all patients make a full recovery. 3,9,22,[24][25][26][27][28][29][30][31][32] Cutaneous exposure is likely underreported and is the most likely coexisting exposure in ophthalmic patients, though symptoms are short lived and self-resolving. 13…”

Inhalation poisoning with palytoxin from aquarium coral: case description and safety advice

“…The threat of PTX poisoning is evident from numerous cases reported around the world (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Its toxicity depends on the route of entry into the body.…”