The correct answer is:

Ciguatera poisoning

Educational Objective:

Discuss ciguatera fish poisoning.

Key Points:

The patient has ciguatera fish poisoning which was caused by her ingestion of grouper (a reef fish).

Explanation:

The clinical presentation of ciguatera poisoning includes gastrointestinal manifestations (e.g., diarrhea, vomiting, nausea, abdominal discomfort), neurologic manifestations (e.g., blurred vision, perioral paresthesias, dysuria, sensation of loose teeth, pruritus, and, occasionally, thermal dysesthesia), and cardiac manifestations (e.g., hypertension, bradycardia, arrhythmias).

Shellfish poisoning can cause neurotoxic poisoning with manifestations similar to ciguatera poisoning, but the symptoms typically occur immediately following ingestion. Shellfish can also cause a paralytic syndrome. There is no history that this patient has ingested shellfish.

Scombroid poisoning is caused by the ingestion of histamine, and flushing and rash are prominent symptoms.

Conversion disorder is a diagnosis of exclusion, and this patient has evidence of a somatic disease, including bradycardia and gastrointestinal manifestations.

Note: The nomenclature of psychosomatic illnesses has undergone multiple changes over the last few years; however, the term “conversion disorder” has endured.

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