SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

C16
A CASE OF TETRODOTOXIN POISONING CAUSED BY INSERTION OF A PUFFER FISH INTO
THE VAGINA
Mikio Yashikil*,Akira Namera l , Kengo Nishioka 2 , Manami Nishida l , Kojiro Kimura l
lDepartment of Legal Medicine, Graduate School of Biomedical Sciences, Hiroshima University and
2Department ofAnesthesia, Chuden Hospital, Hiroshima, Japan.
We report an unusual case of sudden heart and pulmonary failure in a 33 year-old young woman due to
insertion ofa puffer fish into the vagina. While traveling on a boat, the woman felt unwell while having sex
with a man who had inserted a puffer fish into her vagina. Upon arriving at port, she became unconscious and
then went into cardio-pulmonary arrest. She was immediately transported to a hospital where she received
cardio-pulmonary resuscitation. Following an intravenous injection of2 mg ofepinephrine, her heart rate and
blood circulation recovered. Few days later, she began spontaneous breathing, however, her level of
consciousness continued at a low stage (JSC 200). She remained in a vegetable state for two months.
Following her transfer to another hospital, she died of sequential pneumonia two months later. A serum
specimen collected upon admission and a urine specimen collected two days post-admission were found to
contain 58 nglg and 65 nglmL of tetrodotoxin (TTX). TTX in serum and urine was hydrolyzed. to
2-amino-6-hydroxymethyl-8-hydroquinazoline (C 9 -bas)e by NaOH. C 9 -base was purified by CI8"SPE
cartridge and analyzed by GC/MS after TMS derivatization. It is known that some species of puffer fish
release TTX from the skin. In this case, a toxic concentration ofTTX was rapidly absorbed by the victim's
vaginal membrane, distributed throughout her body causing her cardio-pulmonary arrest and eventual death ..
Key words: puffer fish, tetrodotoxin, vagina
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