A 23-year-old Caucasian male presents to the emergency department with an acute onset of flushing, a throbbing headache, palpitations and abdominal cramps. His symptoms began thirty minutes after eating fish at a local restaurant. He says that his two friends who had the same dinner in the restaurant with him had similar but milder symptoms. The particular fish that he ordered in the restaurant is his favorite, and he eats this dish at least twice a month, but this time it tasted unusually spicy. His past medical history is insignificant. Which of the following is the most likely cause of this patient's symptoms?

Question

A 23-year-old Caucasian male presents to the emergency department with an acute onset of flushing, a throbbing headache, palpitations and abdominal cramps.  His symptoms began thirty minutes after eating fish at a local restaurant.  He says that his two friends who had the same dinner in the restaurant with him had similar but milder symptoms.  The particular fish that he ordered in the restaurant is his favorite, and he eats this dish at least twice a month, but this time it tasted unusually spicy.  His past medical history is insignificant.  Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Explanation: The clinical scenario described is consistent with scombroid poisoning, which is caused by the ingestion of improperly stored seafood. If seafood is stored at temperatures exceeding 15C, histidine can undergo decarboxylation and form histamine. Symptoms of scombroid poisoning include flushing, a throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning. These typically begin 10-30 minutes after ingesting the fish, and are self-limited. Patients sometimes describe a bitter taste, but this is not always present. Physical findings may include skin erythema, wheezing, tachycardia and hypotension. (Choice B)Scombroid poisoning is frequently misdiagnosed as an acute allergic reaction; however, the development of similar symptoms in the patient's friends supports the former diagnosis. (Choice E)Pufferfish poisoning is less common than scombroid poisoning, and is characterized by the prominence of neurological symptoms (perioral tingling, incoordination, weakness, etc). (Choice A)Toxic shock is usually accompanied by high fever and hypotension. (Choice C)Carcinoid syndrome is an unlikely diagnosis in this patient because his symptoms are clearly associated with the fish ingestion. Educational Objective: The symptoms of scombroid poisoning include flushing, a throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning. These typically begin 10-30 minutes after ingesting the fish, and are self-limited.

A 23-Year-Old Caucasian Male Presents to the Emergency Department with an Acute