Be careful with undercooked seafood!
A 36 year old previously healthy woman presented with a 2-day history of severe chest pain and epigastric pain associated with nausea and vomiting. Physical examination showed moderate abdominal tenderness, without guarding or rebound in the epigastrium. Laboratory tests, including cardiac enzyme levels, were normal. An electrocardiogram and a radiograph of the chest were normal. The patient reported that she had consumed uncooked salmon approximately 2 hours before the chest pain developed. Computed tomography of the abdomen revealed diffuse thickening of the gastric wall.
Gastroscopy revealed multiple anisakis larvae penetrating into the mucosa in the esophagogastric junction, fundus, upper body, middle body, and antrum of the stomach. Eleven larvae were removed with the use of endoscopic forceps, after which the patient’s symptoms resolved. Anisakiasis is a parasitic infection of the gastrointestinal tract in humans that is caused by the consumption of raw or inadequately cooked seafood containing third-stage larvae of the nematode Anisakis simplex or related species.
Uichiro Fuchizaki, M.D., Masahi Nishikawa, M.D., Keiju Medical Center, Nanao, Japan. Via NEJM