Our patient’s immediate response to a mannitol infusion was consistent with other reported cases of ciguatera poisonings.1 However, mannitol therapy came into question in 2002, when a randomized trial comparing it with normal saline for ciguatera poisoning found that both provided immediate symptom relief.11
THE TAKEAWAY
As tropical fish exports reach new markets and world travel increases, the number of ciguatera cases is likely to continue to rise. The lack of both a specific diagnostic test and an evidence-based treatment highlights the importance of taking a thorough food history—and considering this unusual toxin, as well as more common foodborne pathogens—in patients who present with GI and neurological symptoms.
