VINGT MILLE LIEUES SOUS LES MERS: A POISONOUS GUEST FROM THE BLUE SEA TOXIC INHALATION OF CORAL PALYTOXIN

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: From Raja Ampat, Indonesia to the Red Sea of Indian Ocean, marine corals have attracted myriad of divers and hobbyists around the world with their rainbow-like colors, assorted shapes and unique symbiotic roles However, certain species contain some of the deadliest toxins known to human that can subject handlers to health problems and even life-threatening conditions We report a case of Palythoa coral exposure induced respiratory failure CASE PRESENTATION: A 44-year-old man with childhood asthma presented to the emergency room with sudden onset of shortness of breath His symptoms started one hour prior to his arrival and included chills, dyspnea, chest tightness, pleuritic pain and nausea Further questioning revealed that our patient was cleaning some Palythoa sp corals out from his saltwater aquarium two hours before he fell sick He ran a piece of coral over hot water to kill it It emitted a strong foul odor immediately afterwards He had never attempted such cleaning process before He was not wearing any protective equipment but denied using any cleaning chemicals There was no other pertinent history Initial vital signs included heart rate of 117, respiratory rate of 28 bpm, blood pressure 123/59, and oxygen saturation of 97% on 75%, 40 liters/min High-Flow Nasal Canula He was in mild distress Auscultation revealed decreased bilateral air entry, faint wheezing and mild apical rales Cardiac, abdominal and neurological exams were otherwise benign ABG showed pH of 7 42, PaCO2 41, PaO2 52 and HCO3 26 Chest CT revealed diffuse centrilobular ground-glass opacities in an upper-lobe-predominant distribution Lab studies were significant for lactic acid of 3 4, troponin of 0 44 and BNP at 666 pg/ml CRP was 293 mg/L and procalcitonin of 15 WBC was 27 3 with 85% neutrophils without eosinophilia Complete septic workups including atypical pneumonia pathogens, HIV and COVID-19 were negative Patient’s symptoms subsequently improved with nebulized albuterol treatments, IV steroids and supplemental oxygen He remained on regular floor with intent for discharge in the following days DISCUSSION: Palytoxin (PTX), originally described in a Hawaiian legend, is an extremely poisonous substance synthesized by certain species of corals and dinoflagellates Its lethal power stems from the ability of inactivating the sodium/potassium ATPase pump, thereby destroying cellular ion gradient Ensuing cardiac, respiratory, renal and hematologic dysfunctions have been observed Fewer than 300 cases were ever reported worldwide Most were due to ingestion of contaminated fish, though dermal and inhalational exposure, such as our patient, have been documented CONCLUSIONS: It thus becomes necessary to take PTX poisoning into consideration, whenever compatible history is provided While in vitro and in vivo animal studies have been conducted, there is no known antidote Management is usually supportive Reference #1: Hamade AK, Deglin SE, McLaughlin JB, et al Suspected Palytoxin Inhalation Exposures Associated with Zoanthid Corals in Aquarium Shops and Homes - Alaska, 2012-2014 MMWR Morb Mortal Wkly Rep 2015;64:852 Reference #2: Ramos V, Vasconcelos V Palytoxin and analogs: biological and ecological effects Mar Drugs 2010;8(7):2021-2037 Published 2010 Jun 30 doi:10 3390/md8072021 Reference #3: Thakur LK, Jha KK Palytoxin-induced acute respiratory failure Respir Med Case Rep 2016;20:4-6 Published 2016 Oct 21 doi:10 1016/j rmcr 2016 10 014 DISCLOSURES: No relevant relationships by Mourad Ismail, source=Web Response No relevant relationships by TAWFIQ KARADSHEH, source=Web Response No relevant relationships by William Meng, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Roberto Solis, source=Web Response No relevant relationships by Yasmeen Sultana, source=Web Response no disclosure on file for Qizhi Wang