A friend who dined at a seafood restaurant 3 hours ago calls to describe experiencing tingling and numbness of lips, tongue and fingertips. These symptoms suggest an etiologic agent of:

• A. Scrombotoxin or ciguatoxin
• B. Tetrodotoxin or saxitoxin
• C. Mullet toxicosis
• D. Clostridium type E toxin

Answer: (A)

When tingling around the lips, tongue, and fingertips develops a few hours after eating seafood, think of neurotoxic fish poisoning. Two common culprits match this picture: scombroid (scrombotoxin) and ciguatoxin. Scombroid poisoning occurs when fish, often tuna or mackerel, isn’t kept at proper temperatures and bacteria produce histamine-like compounds; ciguatera toxin comes from certain reef fish that accumulate toxins produced by marine dinoflagellates. Both toxins affect sensory nerves and commonly cause perioral paresthesias within a few hours of ingestion, which fits the 3-hour timeline.

Other toxins listed don’t fit as well. Tetrodotoxin or saxitoxin can cause numbness but usually present with more pronounced weakness or paralysis and are associated with specific sources like pufferfish. Mulleted toxicosis and Clostridium type E toxin don’t typically present with isolated perioral tingling in this setting.