Severe scombroid poisoning and life-threatening hypotension

Area of Science:

• Toxicology
• Clinical Medicine
• Food Safety

Background:

• Scombroid fish poisoning (SFP) is a prevalent global illness caused by histamine accumulation in fish.
• Histamine is a heat-stable toxin, meaning standard cooking methods do not eliminate the risk.
• SFP results from consuming fish with high levels of naturally occurring histamine due to improper storage.

Observation:

• A 48-year-old woman experienced rapid onset of palpitations, tachycardia, and severe hypotension after eating tuna.
• Her symptoms progressed to include facial numbness, flushing, gastrointestinal distress, headache, and chest pain.
• Electrocardiogram (ECG) showed tachycardia with ST depression, and hypotension required phenylephrine treatment.

Findings:

• The clinical presentation, exposure history, and exclusion of other conditions confirmed SFP.
• The patient's hypotension was refractory to initial fluid resuscitation, necessitating vasopressor support.
• Diagnosis was supported by poison control consultation and subsequent notification of the state health department.

Implications:

• Scombroid fish poisoning is frequently misdiagnosed and underreported, potentially leading to severe health consequences.
• This case highlights the critical need for prompt recognition and management of SFP, including vasopressor use.
• Effective treatment, including histamine-receptor antagonists like famotidine, can lead to full recovery, as demonstrated by the patient's discharge with normal ECG and resolution of symptoms.