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June 1993

Another Case of Polymyositis After Ciguatera Toxin Exposure

Author Affiliations

Section of Neurology Dartmouth-Hitchcock Medical Center One Medical Center Dr Lebanon, NH 03756
Division of Geographic Medicine Stanford University School of Medicine Stanford, CA 94305

Arch Neurol. 1993;50(6):571. doi:10.1001/archneur.1993.00540060013009

To the Editor.  —We have described two patients who developed polymyositis several years after ciguatoxin poisoning.1 Another case suggesting a cause and effect relationship between these two entities has come to our attention.In 1979, a 48-year-old businessman ate grouper and snapper caught by spear-fishing around reefs while snorkeling in the Bahamas. After one such meal, he developed soreness and numbness in his fingertips and feet, weakness, and general malaise followed over 3 months by a 18-kg weight loss, arthralgias, myalgias, generalized pruritus, nonproductive cough, and low-grade fever. Six months later, signs included a diffuse erythematous blush that blanched easily to pressure, inspiratory rales at the right base, and diffuse muscle wasting and tenderness. The erythrocyte sedimentation rate was 79 mm, and the creatine kinase level was 558 U/L (normal, <130 U/L). Test results for connective tissue diseases were unrevealing. A chest roentgenogram demonstrated atelectasis; however, further pulmonary workup