Case Report of Tetrodotoxin Poisoning from Lagocephalus sceleratus in Lebanon

• Type of Material: Article
• Authors: Suad Al-Sulaimani, Emory University; Nicholas Vincent Titelbaum, Emory University; Ricardo El Ward, Lebanese University; Tharwat El Zahran, Emory University; Sana Chalhoub, American University of Beirut; Ziad Kazzi, Emory University
• Language: English
• Date: 2022-11-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph192214648
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• Volume: 19
• Issue: 22
• Grant/Funding Information: This research received no external funding.
• Keywords: Science & Technology; ingestion; TAKIFUGU-RUBRIPES; TOXIN; PUFFER FISH CAUGHT; tetrodotoxin; TOXICITY; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; neurotoxicity; pufferfish; TOXIFICATION; Environmental Sciences; Environmental Sciences & Ecology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The Indo-Pacific pufferfish Lagocephalus sceleratus is a tetrodotoxin-containing species believed to have entered the Mediterranean Sea through the Suez Canal. Tetrodotoxin (TTX) is primarily found in the liver, intestine, and ovaries of L. sceleratus. We report a case of a patient with TTX poisoning from L. sceleratus consumption in Lebanon. History of ingestion, clinical presentation, and exam findings were obtained during phone-based consultation with the patient and intensive care physician. A 46-year-old male presented to a hospital in Lebanon with perioral and extremity numbness as well as dizziness 1 h after ingestion of an L. sceleratus fish. He had caught and prepared the fish himself and had eaten a skinless piece of flesh. Over the following 6 h he also developed ataxia and generalized body numbness. His treatment included systemic hydrocortisone, antihistamine, activated charcoal, and fluids. He was admitted to the intensive care unit, where he developed self-limited, stable sinus bradycardia. He was discharged home on hospital day 5 with residual lightheadedness that improved over several days. This is one of the first reported cases of tetrodotoxin poisoning due to L. sceleratus in Lebanon. Public awareness regarding the toxicity of this species after any ingestion is essential to prevent toxicity and death.