A 47 y.o. male became short of breath after cleaning the corals in his fish tank.

The patients xray is shown as well as his 15 y.o. son.

fathers xray

sons xray 24 hrs after admission What could have happened?

coral containing palytoxin

The patient was exposed to palytoxin which is a highly toxic fatty alcohol produced by corals and other marine invertebrates. The toxin was first  described by ancient Hawaiians who called it imu-make-o-Hana which means “seaweed of death from Hana”. Poisoning events are rare although at times there are outbreaks of toxicity.  Hundreds of people became ill in Genoa Italy when an algae bloom in 2005 created aerosolized toxin. 

the blue ringed octopus contains tetrodotoxin;

The effects of the palytoxin are vasoconstriction and leakage of K from cells destroying the cellular gradient.  Rhabdomyolysis can develop as well as renal failure and cardiac arrest.

In addition to corals (which are animals referred to an cnidarians because they contain specialized cells used to capture prey called cnidocytes), other invertebrates have caused outbreaks of  illness.  Crabs ( Demania Reynaudii) , smoked fish and parrotfish have all been implicated in deaths. In these cases the toxin was ingested rather than inhaled.

the puffer fish also contains tetrodotoxin in its organs.

Our patient required frequent nebs and was in the ICU for several days.  His son was hypotensive and required pressors but no intubation.  Both have recovered.

The box jellies of Australia contain a potent toxin; another cnidarian

Gerssen A, Pol-Hofstad  I, Poelman M, Mulder  P, et al. Marine toxins: chemistry, toxicity, occurrence and detection, with special reference to the Dutch situation.  Toxins 2010 Apr;2(4):878-904.

Hoffmann K, Hermanns-Clausen M, buhl C, et al. A case of palytoxin poisoning due to contact with zoanthid corals through a skin injury. 2008. Toxicon. 51(8):1536-7.

Lago J, Rodriguez LP, Blanco L, et al. Tetrodotoxin, an extremely potent marine neurotoxin: distribution, toxicity, origin and therapeutical uses. Mar Drugs. 2015 Oct;13(10):6384-6460.