DOI: 10.36347/SJMCR.2019.v07i11.019

Pages: 719-722

Ingestion of pufferfish can be extremely dangerous due to its poison. Victims may present with wide range of neurological and gastrointestinal symptoms. Manifestation may include nausea, vomiting, abdominal pain, numbness to perioral area, tongue and face, as well as muscle weakness and respiratory paralysis. In severe toxicity, cardiovascular system can be affected as well. In addition to severe hypotension, bradycardia and arrhythmias, patients may suffer convulsion and enter into deep coma. In this case report we describe a 40 years old male who ate puffer fish and went on to develop an extensive subarachnoid hemorrhage. The patient was transferred to our medical center on a ventilator. External ventricular drain was inserted for hydrocephalus. Intracranial pressure was kept within normal range. Digital subtraction angiography performed in our center excluded vascular pathology. During intensive care unit stay, the patient consistently spiked temperatures to 39 Celsius and above. The patient could be extubated 2 weeks later with a Glasgow coma scale of 13-14. External ventricular drain could also be removed but he soon became irritable, highly febrile, tachycardic and tachypneic with distended abdomen. Patient was re-intubated but progressed to fixed dilated pupils and sustained a cardiac c arrest from which he could not be resuscitated.