DDSEP® 8 Quick Quiz

Quick Quiz Question 2

Publish date: October 1, 2021

Q2. A 54-year-old man is seen in the clinic for a recent episode of nausea, vomiting, and abdominal pain. He was vacationing with friends in Hawaii, and 1 hour after eating a local dish consisting of rice, macaroni salad, and raw tuna, he developed a headache associated with facial flushing, upper body rash, palpitations, nausea, vomiting, and abdominal pain. His friends who ate burgers did not experience any symptoms. He felt better the next day. He takes only lisinopril for hypertension and has no known drug allergies. His physical examination is unremarkable. Although he has tolerated fish in the past, he did some research on the internet and wonders if he has a seafood allergy.

Which of the following is correct regarding this case?

This event would have been prevented by immediate and proper refrigeration of fish after catch.

Ciguatera poisoning may be prevented by thoroughly cooking all fish.

The patient's symptoms are caused by accumulation of dinoflagellate toxins in large fish.

The patient's lisinopril should be discontinued.

The patient should undergo food allergy testing.

Q2. Correct answer: A.

Rationale
Tropical sprue occurs in patients from or travelers to endemic areas near the equator, such as Puerto Rico, Haiti, Cuba, Southeast Asia, and India for at least 2 weeks to a month and has a likely infectious etiology, but the exact organism(s) has not been identified. Patients may present with malabsorption, steatorrhea, weight loss, and fatigue. Laboratory testing shows anemia, B12 and folate deficiency, and increased fecal fat. Biopsies of the small bowel during upper endoscopy show villous blunting with negative celiac serologies. Treatment is a 3- to 6-month course of tetracycline 250 mg orally four times daily with folate 5 mg orally daily. The macrocytic anemia, normal iron studies, and low vitamin B12 and folate levels argue against celiac disease, so this patient is unlikely to respond to a gluten-free diet.

References
Ghoshal UC et. al. Curr Gastroenterol Rep. 2014;16(6):391.
Batheja MJ et. al. Case Rep Gastroenterol. 2010 May 19;4(2):168-172.
Jansson-Knodell CL et al. Mayo Clin Proc. 2018 Apr;93(4):509-517.

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