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A Case of Histamine Fish Poisoning in a Young Atopic Woman

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Abstract

Histamine fish poisoning, also known as scombroid poisoning, is a histamine toxicity syndrome that results from eating specific types of spoiled fish. Although typically a benign syndrome, characterized by self-limited flushing, headache, and gastrointestinal symptoms, we describe a case unique in its severity and as a precipitant of an asthma exacerbation.

A 25-year-old woman presented to the emergency department (ED) with one hour of tongue and face swelling, an erythematous pruritic rash, and dyspnea with wheezing after consuming a tuna sandwich. She developed abdominal pain, diarrhea and hypotension in the ED requiring admission to the hospital. A diagnosis of histamine fish poisoning was made and the patient was treated supportively and discharged within 24 hours, but was readmitted within 3 hours due to an asthma exacerbation. Her course was complicated by recurrent admissions for asthma exacerbations.

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Acknowledgement

The authors thank the public health inspectors, Larry Crowe, CPHI(C) and Sarah Nunn, CPHI(C), for there valuable efforts in patient, food store, and Canadian Food Inspection Agency follow up. In addition, they would like to express their appreciation to Dr Tiffany Poon, who had helped to care for the patient during her brief hospitalization. No funding was provided for the study. A portion of this manuscript was presented as a poster at the Society of General Internal Medicine Annual Meeting in Pheonix on May 5, 2011.

Conflict of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

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Authors and Affiliations

  1. Department of Medicine, University of Calgary, Room EG23, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada

    Ben J. Wilson MD & William A. Ghali MD, MPH

  2. Alberta Health Services, Calgary, AB, Canada

    Richard J. Musto MD

  3. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Richard J. Musto MD & William A. Ghali MD, MPH

Authors
  1. Ben J. Wilson MD
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  2. Richard J. Musto MD
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  3. William A. Ghali MD, MPH
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Corresponding author

Correspondence to Ben J. Wilson MD.

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Key points

1. Histamine fish toxicity is generally a benign, self-limited illness that does not require therapy.

2. Clinicians should recognize that a history of atopy can result in a prolonged and complicated course.

3. Severe cases should be considered in the differential diagnosis of anaphylaxis.

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Wilson, B.J., Musto, R.J. & Ghali, W.A. A Case of Histamine Fish Poisoning in a Young Atopic Woman. J GEN INTERN MED 27, 878–881 (2012). https://doi.org/10.1007/s11606-012-1996-6

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  • DOI: https://doi.org/10.1007/s11606-012-1996-6

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