Ciguatera is a common marine, toxin-borne illness caused by the consumption of fish that contain toxins that activate voltage-sensitive sodium channels. The clinical manifestations of ciguatera are typically self-limited, but chronic symptoms may occur in a minority of patients. This report describes a case of ciguatera poisoning with chronic symptoms, including pruritus and paresthesias. A 40-y-old man was diagnosed with ciguatera poisoning after consuming amberjack while vacationing in the US Virgin Islands. His initial symptoms, including diarrhea, cold allodynia, and extremity paresthesias, evolved into chronic, fluctuating paresthesias and pruritus that became worse after the consumption of alcohol, fish, nuts, and chocolate. After a comprehensive neurologic evaluation failed to reveal another cause for his symptoms, he was diagnosed with chronic ciguatera poisoning. His neuropathic symptoms were treated with duloxetine and pregabalin, and he was counseled to avoid foods that triggered his symptoms. Chronic ciguatera is a clinical diagnosis. Signs and symptoms of chronic ciguatera can include fatigue, myalgias, headache, and pruritus. The pathophysiology of chronic ciguatera is incompletely understood but may involve genetic factors or immune dysregulation. Treatment involves supportive care and avoidance of foods and environmental conditions that may exacerbate symptoms.
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- Neurotoxic marine poisoning.Lancet Neurol. 2005; 4: 219-228
- Neurological disturbances of ciguatera poisoning: clinical features and pathophysiological basis.Cells. 2020; 9: 2291
- Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults.Am J Trop Med Hyg. 2007; 77: 842-846
- A curious case of ciguatera fish poisoning in the Midwest and a review for clinicians.J Emerg Med. 2020; 58: e109-e111
- Epidemiology and clinical features of ciguatera fish poisoning in Hong Kong.Toxins. 2014; 6: 2989-2997
- Screening for predictors of chronic ciguatera poisoning: an exploratory analysis among hospitalized cases from French Polynesia.Toxins. 2021; 13: 646
- Chronic ciguatoxin poisoning causes emotional and cognitive dysfunctions in rats.Toxicol Res. 2016 8; 6: 179-187
- Defining the neurotoxin derived illness chronic ciguatera using markers of chronic systemic inflammatory disturbances: a case/control study.Neurotoxicol Teratol. 2010; 32: 633-639
- Gene expression patterns in peripheral blood leukocytes in patients with recurrent ciguatera fish poisoning: preliminary studies.Harmful Algae. 2016; 57: 35-38
- Ciguatera fish poisoning: a first epidemic in Germany highlights an increasing risk for European countries.Toxicon. 2014; 91: 76-83
- Is mannitol the treatment of choice for patients with ciguatera fish poisoning?.Clin Toxicol. 2017; 55: 947-955
- Symptomatic improvement of chronic fatigue with fluoxetine in ciguatera fish poisoning.Med J Aust. 1992; 157: 567
- An updated review of ciguatera fish poisoning: clinical, epidemiological, environmental, and public health management.Mar Drugs. 2017; 15: 72
Published online: March 02, 2023
Accepted: January 5, 2023
Received: November 1, 2022
Publication stageIn Press Corrected Proof
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