Adult Acute Flaccid Paralysis Associated With Food Consumption: A Tetrodotoxin Poisoning Case Report and Differential Diagnosis.

Abstract

Acute flaccid paralysis (AFP) in adults is a clinical emergency with multiple causes, including hypokalemic periodic paralysis (hypoPP), Guillain-Barré syndrome (GBS), myasthenia gravis (MG), and botulinum neurotoxin (BoNT) poisoning. Herein, we present the case of a 64-year-old Asian man who ingested an unidentified fish. Within 30 minutes of ingestion, he developed flaccid paralysis along with gastrointestinal symptoms and perioral tingling. After 3 hours, his condition deteriorated to worsening respiratory distress and unconsciousness, requiring mechanical ventilation for one week. Blood and urine samples tested positive for 11-norTTX-6-ol, a tetrodotoxin (TTX) analog. Cytochrome b (Cytb) gene analysis of the remaining consumed fish revealed that the fish was Lagocephalus lunaris. Although TTX poisoning is rare, some countries have relatively high rates due to regional factors. When immediate laboratory confirmation is not possible, analysis of patient clinical history is crucial for diagnosis. Because this condition progresses rapidly, prompt stabilization of vital signs by clinicians increases the likelihood of survival and reduces the risk of death.