CIGUATERA FISH POISONING FOLLOWING TRAVEL TO THE TROPICS

A 40-year-old man - as well as 15 more participants of the same meal - suddenly experienced vomiting and watery diarrhea four hours after ha ving eaten a meal of grouper in the Dominican Republic. Symptoms persi sted for four hours and were followed by a generalized pruritus and pa resthesias of the lips, tongue, palms, and soles of the feet. Physical examination was normal with the exception of a pulse of 45 beats per minute, a blood pressure of 80/50 mmKg, and paradoxical temperature pe rception. Laboratory values were regular except for the erythrocyte se dimentation rate of 40 mm per hour. 24-hour Holter electrocardiogram s howed a normal sinus rhythm with impaired heart rate variability (37-1 00 beats per minute). Due to the typical history and the clinical find ings, ciguatera toxin ingestion was diagnosed. Pruritus decreased slig htly with symptomatic therapy: but it took 16 weeks for all symptoms t o resolve. Ciguatera fish poisoning is rare in temperate countries. Sy mptoms of this neurotoxic disease are gastrointestinal, neurologic, an d cardiovascular manifestations with paresthesias, paradoxical sensor disturbances, and muscular weakness as well as bradycardia and hypoten sion. With travel to and from the tropics and increasing imports of tr opical fish ciguatera will be of growing importance even in nontropica l areas.