T-2 Mycotoxin

Case history

A 38-year-old previously healthy male presents 24 hours after an exposure to a mist with rhinorrhoea, sore throat, blurred vision, vomiting, diarrhoea, skin irritation (burning and itching), and dyspnoea. There were several others involved in this event who were taken to other hospitals. His symptoms continue to develop with further nausea and vomiting, diarrhoea, burning erythema, skin rash and blisters, confusion, ataxia, chills, fever, and hypotension. The examination reveals a pulse of 112 bpm, respiratory rate is 27 breaths per minute, and blood pressure is 94/63 mm/Hg. The patient’s temperature is normal. Examination reveals conjunctivitis, and erythematous skin rash on sun-exposed areas. Auscultation of his chest reveals widespread crackles and wheeze. Pertinent laboratories reveal bicarbonate 19 mmol/L (19 mEq/L), blood urea level 12.5 mmol/L (35 mg/dL), creatinine 132.6 micromol/L (1.5 mg/dL), and urine specific gravity 1.028. ELISA antibody tests conducted by national authorities are positive for trichothecene mycotoxins.