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A Scombroid Poisoning Causing a Life-Threatening Acute Pulmonary Edema and Coronary Syndrome in a Young Healthy Patient

Department of Experimental and Applied Medicine, University of Brescia, Piazzale Spedali civili, 125100 Brescia, Italy.
Cardiovascular toxicology (Impact Factor: 2.06). 05/2011; 11(3):280-3. DOI: 10.1007/s12012-011-9115-1
Source: PubMed
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    ABSTRACT: Background Scombroid syndrome (histamine fish poisoning) includes symptoms and signs caused by biogenic amines, mainly due to histamine-containing food. Methods and results In this report, we describe a 56 year old female who presented in the clinic with symptoms of scombroid syndrome after the ingestion of tuna fish, then gradually developed cardiovascular shock and inferior ST elevation myocardial infarction (STEMI) associated with advanced second grade atrio-ventricular block at the electrocardiogram (ECG) followed by respiratory arrest. Originally, the patient was treated with intravenous fluid infusion, steroids, ranitidine and chlorpheniramine. Following her cardiovascular shock and respiratory arrest, orotracheal intubation was performed and mechanical ventilation was started immediately. The patient was treated with dobutamine and fluid infusion, which has improved her hemodynamic conditions. Emergency cardiac catheterization was performed one hour after the onset of symptoms and coronary angiography did not show a significant coronary artery disease. The clinical picture has improved during the next days, with complete normalization of the ECG. Conclusion Severe symptoms, including myocardial infarction. may occur in cases of scombroid syndrome.
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    ABSTRACT: We report a case of anaphylactoid shock with ventricular fibrillation and myocardial necrosis that occurred in a 61-year-old patient twenty minutes after eating cooked fish. An allergic cause was excluded by negative allergic explorations and good tolerance of subsequent fish consumption. A diagnosis of scombroid food poisoning (SFP) was made. SFP results from eating fish spoiled by inadequate refrigeration. The fish becomes contaminated by bacteria which then convert fish muscle histidine into histamine. Typical symptoms of histaminic intoxication include a metallic taste, erythema, sweating, nausea, diarrhea, palpitations, and sometimes facial oedema. Myocardial involvement is rare but not exceptional. SFP is the main differential diagnosis in cases of suspected fish allergy.
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