Flushing syndrome due to mahimahi (scombroid fish) poisoning

Abstract

Scombroid fish poisoning, one of the most common adverse reactions to fish, is also probably one of the most common causes of a flushing syndrome. The reaction usually involves fishes of the Scombridae family but, in Hawaii, the reaction is most often due to mahimahi (Coryphaena hippurus). Onset of the reaction is usually abrupt and commonly associated with a prominent flush resembling a sunburn. Headache, tachye to a toxin with histamine-like properties, which is formed because improper refrigeration enables endogenous bacteria to decarboxylate histidine normally present in dark-meat fishes. Symptoms are usually promptly relieved by parenteral antihistamine therapy.

Scombroid poisoning: A review

“…The onset of scombroid poisoning is typically from 10 min to 1 h following consumption of poisonous fish (Ansdell, 2008). The symptoms (Arnold and Brown, 1978;Kim, 1979;Gilbert et al, 1980;Taylor, 1986) are variable and include peppery or metallic taste, oral numbness, headache, dizziness, palpitations, rapid and weak pulse (low blood pressure), difficulty in swallowing, and thirst. Noteworthy as allergy-like are symptoms such as hives, rash, flushing and facial swelling (Kim, 1979;Taylor et al, 1989).…”

“…The symptoms (Arnold and Brown, 1978;Kim, 1979;Gilbert et al, 1980;Taylor, 1986) are variable and include peppery or metallic taste, oral numbness, headache, dizziness, palpitations, rapid and weak pulse (low blood pressure), difficulty in swallowing, and thirst. Noteworthy as allergy-like are symptoms such as hives, rash, flushing and facial swelling (Kim, 1979;Taylor et al, 1989). Symptoms involving the central nervous system (CNS) such as anxiety (Russell and Maretic, 1986;Sabroe and Kobza Black, 1998;Specht, 1998) are less frequently observed.…”

Brief Toxicology Observation: What Kind of Burger Did This Patient Eat?

“…being sunburn-like in appearance, and found from the "nipples up" although this is based on a series of six cases from 1979 and is not always true as in our case [1]. Scombroid poisoning was first described with the dark muscle fish of the Scombridae and Scomberesocidea family (e.g., tuna, mackerel, skipjack) due to high concentration of free histidine in their tissue.…”