Visual Diagnosis in Emergency Medicine
A Fish Tale: Flushing and Pruritis after Tuna Ingestion

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Introduction

Scombroid poisoning is a disease mediated by a large ingestion of histamine-14-contaminated fish. Symptoms can range from mild flushing and pruritus to severe disease with cardiovascular and hemodynamic instability. We present the case of a woman who ingested fully cooked tuna and subsequently developed a reaction consistent with scombroid poisoning.

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Case Report

A 65-year-old woman presented with the sudden onset of feeling “hot,” accompanied by a diffuse, blanching red rash, conjunctival injection, and one episode of non-bloody diarrhea. It happened suddenly about 90 min after consuming a dinner that included fully cooked tuna. It was also associated with mild diffuse pruritus, and the patient reported feeling restless. The patient reported that her husband had similar but milder symptoms, including flushing and diarrhea. She denied any prior similar

Discussion

Although scombroid poisoning is common throughout the world, it accounts for only about 0.5% of reported foodborne illnesses in the United States. Fewer than 100 cases are reported per year, as the symptoms are very similar to an allergic reaction. It is often misdiagnosed as a “seafood allergy,” which would be an incorrect statement. Unfortunately, the true incidence is probably much higher, because it is so infrequently reported and incorrectly diagnosed (1).

Scombroid is associated with

Conclusion

Scombroid poisoning is a relatively undiagnosed disorder, although studies suggest its actual incidence is much more common. It is always important to keep a high level of suspicion when patients present with similar complaints (see Figure 1).

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References (13)

  • D. Mines et al.

    Poisonings: food, fish, shellfish

    Emerg Med Clin North Am

    (1997)
  • Centers for Disease Control and Prevention (CDC)

    Scombroid fish poisoning associated with tuna steaks—Louisiana and Tennessee, 2006

    MMWR Morb Mortal Wkly Rep

    (2007)
  • O. Lavon et al.

    Scombroid fish poisoning in Israel, 2005-2007

    Isr Med Assoc J

    (2008)
  • G. Predy et al.

    Was it something she ate? Case report and discussion of scombroid poisoning

    CMAJ

    (2003)
  • L.E. Fleming et al.

    Scombroid fish poisoning

    Shoreland Travel Med Mon

    (1998)
  • R. Kim

    Flushing syndrome due to mahimahi (scombroid fish) poisoning

    Arch Dermatol

    (1979)
There are more references available in the full text version of this article.

Cited by (2)

  • Quality assurance of histamine analysis in fresh and canned fish

    2016, Food Chemistry
    Citation Excerpt :

    The sensory characteristics of the affected fish may appear satisfactory as high histamine levels may not be accompanied by other signs of spoilage. Therefore, the risk of histamine poisoning has attracted the attention of the international community which is concerned with public health and safety issues, as well as with the global fish trade (Bucher & Calello, 2013; D’Aloia et al., 2011; Demoncheaux et al., 2012; Feng, Teuber, & Gershwin, 2015; Mahmoudi & Norian, 2014; Tortorella et al., 2014; Wilson, Musto, & Ghali, 2012; Yesudhason et al., 2013). In 1996, the United States Food and Drug Administration (FDA) implemented the seafood Hazard Analysis and Critical Control Point (HACCP) program to prevent seafood processing hazards that could lead to foodborne illness.

  • Scombroid Poisoning: A Practical Approach

    2016, Actas Dermo-Sifiliograficas
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