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A case of Ciguatera poisoning with paradoxical dysaesthesia and degenerative features at skin biopsy

      Ciguatera poisoning is a widespread seafood-toxic illness, endemic in the tropical and subtropical regions of Caribbean and Indo-Pacific. It is the most frequently reported marine toxin-related poisoning globally. The climate and environment changes together with the international commerce and consumption of frozen fish species are responsible for an increasing number of Ciguatera poisoning also in temperate regions [
      • Mattei C.
      • Vetter I.
      • Eisenblätter A.
      • Krock B.
      • Ebbecke M.
      • Desel H.
      • Zimmermann K.
      Ciguatera fish poisoning: a first epidemic in Germany highlights an increasing risk for European countries.
      ]. Ciguatoxins are produced by dinoflagellates of the Gambierdiscus species, bottom-dwelling single-cell organisms living in the coral reef. Ciguatoxins are lipophilic, soluble, heat-stable polycyclic polyethers, which are stored in finfish viscera and concentrate and bioaccumulate up the food chain from small reef fish to the large carnivorous species. They are grouped in 3 variants, depending on their origin from the Pacific (P-CTX), Caribbean (C-CTX) and Indian Ocean (I-CTX) [
      • Dickey R.W.
      • Plakas S.M.
      Ciguatera: a public health perspective.
      ].

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