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.
Keywords
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Article info
Publication history
Published online: March 02, 2023
Accepted:
January 5,
2023
Received:
November 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
