The Case Files: Disease Traveling by Plane

By Hirashima, Eva Tovar MD, MPH; Crucio, Ted MD   A 34-year-old woman presented to the ED complaining of nausea, vomiting, and body tingling. She had just returned from a one-week stay in Haiti. Four days prior to presentation, she had eaten red snapper in a local restaurant. A few hours after the ingestion, she had colicky abdominal pain, watery non-bloody diarrhea, and circumoral tingling, which later progressed to generalized itching, tingling, and intense burning.   The patient reported on arrival at our ED improvement of the diarrhea, but the generalized itching and tingling had worsened, and she complained of fatigue and weakness. She also endorsed a burning sensation whenever she touched cold water. She denied any past medical or surgical history, fever, blurry vision, gait abnormalities, chest pain, and palpitations.   Her temperature was 99.4°F, her pulse was 53 beats per minute, blood pressure was 114/52 mm Hg, her respiratory rate was 18 breaths per minute, and her O2 Sat was 100% on room air. She was well appearing, although she kept scratching throughout the exam. Her physical exam was notable for moist mucous membranes, a regular heart beat despite being bradycardic at triage, and a soft, nontender and nondistended abdomen. Neurological examination revealed a normal mental status and motor exam, but she had diminished pinprick sensation with stocking distribution at her wrist and ankle.   The ED workup consisted of a CBC, BMP, and a lactic acid, but the res...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research