[Case of tetrodotoxin intoxication in a uremic patient]

Ingestion of certain types of puffer fish can result in severe and potentially lethal intoxication, referred to as tetrodotoxin (TTX) intoxication. It is well known that respiratory support plays a key role in the management of patients with TTX intoxication. We describe here the case of a 52-year-old uremic woman, who complained of numbness of the lips and weakness in the legs after ingestion of puffer fish (Lagocephalus wheeleri; called shirosaba-fugu in Japanese). While her symptoms were not severe and she did not require respiratory support, her condition did not improve after 2 days of hospitalization. Hemodialysis was therefore performed on hospital days 3, 4 and 5, and resulted in marked improvement of symptoms. We suggest that the patient's renal dysfunction caused an accumulation of TTX due to delayed excretion and thus modified the clinical course of TTX intoxication. Hemodialysis may be effective in the treatment of TTX intoxication. This is the first report of TTX intoxication in a uremic patient in Japan, and, importantly, the first report of intoxication with Lagocephalus wheeleri, which was previously considered to be a non-toxic species.