SHM Converge Scientific Abstract ePoster Gallery-Toxins at the Table: A Rare Case of Paralytic Shellfish Poisoning and Klebsiella Bacteremia

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This case report describes a 51-year-old woman who presented with acute altered mental status, severe headache, abdominal pain, nausea, dysarthria, and flaccid upper extremity weakness a few hours after eating shrimp scampi. In the emergency department, she was febrile, tachycardic, and mildly hypotensive, with labs showing mild hypokalemia, acute kidney injury, thrombocytopenia, elevated lactate, and markedly elevated procalcitonin. Brain and vascular imaging were negative for stroke. Because of concern for meningitis or encephalitis, she initially received broad empiric treatment with ceftriaxone, ampicillin, acyclovir, dexamethasone, and IV fluids.<br /><br />Subsequent cerebrospinal fluid studies were not consistent with CNS infection, but blood cultures grew Klebsiella pneumoniae. Given the rapid onset after shellfish ingestion and the characteristic neurologic symptoms, she was clinically diagnosed with paralytic shellfish poisoning (PSP), likely caused by saxitoxin exposure. PSP occurs when saxitoxins block voltage-gated sodium channels, disrupting nerve conduction and causing paresthesias, weakness, dysarthria, ataxia, and potentially respiratory failure.<br /><br />The case highlights the diagnostic difficulty of PSP because it can mimic stroke and central nervous system infections. Fever and elevated inflammatory markers are unusual for PSP and may mislead clinicians toward infection. In this patient, the positive blood cultures suggested a concurrent bacteremia, possibly from gastrointestinal translocation, creating a dual-diagnosis scenario.<br /><br />Her neurologic symptoms improved rapidly within 24 hours with supportive care, and antibiotics were narrowed to oral cefuroxime. She was discharged on hospital day 4 in full recovery. The report emphasizes the importance of considering PSP in patients with acute neurologic symptoms after shellfish consumption, while also remaining alert for possible simultaneous bacterial infection.

Asset Subtitle

Amir Abusharif

Meta Tag

Author List Amir Abusharif, Komlan E. Guedze, Muhammad R. Nazir, Shanaz Azad

Category Clinical Vignettes

Concept Paralytic Shellfish Poisoning

Concept Saxitoxin

Concept Neurologic Deficit

Concept Voltage-Gated Sodium Channels

Concept Supportive Care

Distinguished Non-Finalist

Presenter Organization Franciscan Health Olympia Fields

Presenting Author Amir Abusharif

Track Adult

Keywords

paralytic shellfish poisoning

saxitoxin

shellfish ingestion

acute altered mental status

dysarthria

flaccid weakness

Klebsiella pneumoniae

bacteremia

stroke mimic

cerebrospinal fluid

Paralytic Shellfish Poisoning

Saxitoxin

Neurologic Deficit

Voltage-Gated Sodium Channels

Supportive Care