Ciguatera or why you should enquire about fish consumption in cases of cold allodynia

Ciguatoxins (CTX) are potent marine biotoxins produced by microalgae, which may accumulate seasonally, and which are locally variable in tropical predatory fish. Gastrointestinal, neurologic and/or cardiovascular symptoms occur shortly after the consumption of fish. Due to the high affinity of CTX to neuronal sodium channels, neurologic symptoms constitute a hallmark of ciguatera fish poisoning (CFP). Almost pathognomonic for CFP is an alteration of temperature perception (cold allodynia), in which cold surfaces are perceived as hot, painful, or produce dysesthesia (unpleasant, abnormal sensation). Increasing imports of tropical fish have led to more frequent reports of ciguatera in temperate climatic zones. We illustrate the specific features of CFP by reporting two cases due to imported tropical fish.