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Case Reports in Emergency Medicine
Volume 2015, Article ID 597934, 4 pages
http://dx.doi.org/10.1155/2015/597934
Case Report

Scombrotoxinism: Protracted Illness following Misdiagnosis in the Emergency Department

1Occupational Medicine & Toxicology, Royal Medical Group, 1120 W. Warner Avenue, Santa Ana, CA 92707, USA
2University of Washington, Seattle, WA 98104, USA
3Royal Medical Group, 1120 W. Warner Avenue, Santa Ana, CA 92707, USA
4MidMichigan Medical Center, Midland, MI 48640, USA

Received 28 May 2015; Accepted 2 July 2015

Academic Editor: Aristomenis K. Exadaktylos

Copyright © 2015 Ghan-Shyam Lohiya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Scombrotoxinism is an acute toxin-induced illness caused primarily by bacterial synthesis of histamine in decomposed fish. Case Report. Immediately after taking 2-3 bites of cooked salmon, a clerical worker developed oral burning, urticaria, and asthma. In the emergency department, she was diagnosed with “allergies”; scombrotoxinism was never considered. She then developed wide-ranging symptoms (e.g., chronic fatigue, asthma, anxiety, multiple chemical sensitivity, and paresthesiae) and saw many specialists (in pulmonology, otorhinolaryngology, allergy, toxicology, neurology, psychology, and immunology). During the next 500+ days, she had extensive testing (allergy screens, brain MRI, electroencephalogram, electromyogram, nerve conduction velocity, heavy metal screen, and blood chemistry) with essentially normal results. She filed a workers’ compensation claim since this injury occurred following a business meal. She was evaluated by a Qualified Medical Evaluator (GL) on day 504, who diagnosed scombrotoxinism. Comment. Scombrotoxinism should be considered in all patients presenting to the emergency department with “oral burning” or allergy symptoms following “fish consumption.” Initial attention to such history would have led to a correct diagnosis and averted this patient’s extended illness. Specialist referrals and tests should be ordered only if clinically indicated and not for diagnostic fishing expedition. Meticulous history is crucial in resolving clinical dilemmas.