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Blow: a case of pufferfish intoxication in South Florida
  1. Patricia Almeida,
  2. Raiko Diaz,
  3. Felix Hernandez and
  4. Gustavo Ferrer
  1. Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
  1. Correspondence to Dr Patricia Almeida, palmeida617{at}


We report the case of a 43-year-old African American man with a history of hypertension and chronic kidney disease presenting with hypertensive emergency and bulbar paralysis in a descending fashion, which ultimately led to acute respiratory failure. He ingested pufferfish liver during the preceding 4 hours prior to presentation, as well as canned foods and cocaine over the prior 3 days. He had a complicated hospital course requiring intubation and mechanical ventilation, as well as the development of acute respiratory distress syndrome and acute renal failure requiring haemodialysis. This case exemplifies the classic manifestations of tetrodotoxin poisoning with some unique overlapping features, in the setting of an interesting social history.

  • toxicology
  • drugs: respiratory system
  • mechanical ventilation
  • drugs: CNS (not psychiatric)
  • neuromuscular disease

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  • Contributors PA is the main author of the manuscript. RD reviewed pertinent literature and helped with the draft of the original article. FH and GF helped revising the draft and produce the final manuscript submitted for publication.

  • 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.