ID Case ConferenceJanuary 9, 2008.ppt

ID Case ConferenceJanuary 9, 2008 Carlos M. Perez, MD, FACP Associate Professor of Medicine Pontificia Universidad Catolica de Chile Case 1 2 HPI: Two women (sisters in law), 30 yo and 37 yo respectively, while they were on vacations with their husbands and children (three each), in Punta Cana, Dominican Republic, developed similar symptoms. They saw several Physicians before coming to see us. Case 1 2 HPI Patient # 1: Episode of watery diarrhea. Several hours later, dysesthesia developed, along with intense pruritus of the legs, hands, and breasts, which increased with exposure to cold. HPI Patient # 2: Episode of watery diarrhea. Several hours later developed dysesthesia, generalized pruritus and sharp, shooting pain in her legs. In both patients, the symptoms were disabling and persisted for weeks. They are sportswomen and denied eating “junk food” as their families did. No mosquito bites. No consumption of uncooked shellfish/fish. No contact with animals. Husbands and children were healthy and asymptomatic. Case 1 2 PMH PSH: Unremarkable Medications: Acetaminophen, Ibuprofen. NKDA SH: Married, three children. No sexual contact other than husband. No Etoh or tobacco use. ROS: Fever(-), weight loss (-), skin rash (-), HA (-), insomnia (+) (due to pruritus and pain), GI symptoms (-) except for initial diarrhea. Join pain or swelling (-) Case 1 2 PE: Both afebrile, normal pulse and BP. No skin rash. No lymphadenopathy. HEENT wnl. Lungs and Heart wnl. Breasts wnl. Abdomen wnl. Neurological examination: Mental status wnl. Normal sensation and strength. Normal reflexes. Meningeal signs (-) Case 1 2 Laboratory test: CBC, chemistry, UA, Sed rate, CRP wnl. Case 1 2 Discussion Case 1 2 Diagnosis: Ciguatera Poisoning Case 1 2 Diagnosis: Ciguatera Poisoning How they got it? Case 1 2 Because they ate Dusky grouper (“Mero”) (Epinephelus marginatus) Marine Toxins As world travel and trade grow, physicians are increasingly likely to encounter patients suff