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Junctional bradycardia caused by ciguatera intoxication
  1. Rajendra Raman1,2,
  2. Sarah Coppes2,3,
  3. Tessa Hellingman2,4 and
  4. Casper Laclé2
  1. 1 Accident and Emergency, NHS Fife, Kirkcaldy, UK
  2. 2 Emergency Department, Dr Horacio E Oduber Hospital, Oranjestad, Aruba
  3. 3 Emergency Department, Spaarne Gasthuis, Haarlem, The Netherlands
  4. 4 VU medisch centrum School of Medical Sciences, Amsterdam, The Netherlands
  1. Correspondence to Dr Rajendra Raman, rajendra.raman{at}


Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.

  • arrhythmias
  • poisoning

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  • Contributors RR, SC and TH initially assessed and managed the patient in the emergency department. CL was the consultant who admitted and managed the patient in the coronary care unit and arranged subsequent follow-up. RR conceived the case report and wrote the clinical history and background. SC reviewed and summarised the literature on ciguatera presentation, and commented on other sections. TH reviewed and summarised the literature on management, and commented on other sections. CL oversaw the writing of the report and made comments on each section, all of which were incorporated in the final report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.