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A diagnostic red herring
  1. Alexander J Martin-Bates1,
  2. Charles Martin-Bates2,
  3. Richard Withnall3
  1. 1 Medical Reception Station, Defence Medical Services, Dhekelia Station, UK
  2. 2 GP, Reading, Berkshire, UK
  3. 3 Royal Centre for Defence Medicine, Defence Medical Services, Birmingham, UK
  1. Correspondence to Dr Alexander J Martin-Bates, Medical Reception Station, Defence Medical Services, Dhekelia Station, BFPO 58, UK; alexander.martin-bates966{at}


Clinical introduction A 29-year-old keen parachutist presented to the emergency services in Cyprus complaining of sudden-onset facial flushing, dizziness and a widespread rash. The episode began on a hot day, 1 hour after she had eaten a breakfast of tinned tuna, and while she was ascending in an aircraft to parachute from 10 000 ft. She completed her jump uneventfully. She had no significant medical history (figure 1).

Figure 1

Patient’s legs on presentation; this rash was generalised.

Question Based on the history and rash, which ONE of the following is the most likely diagnosis?

  1. Fish allergy

  2. Heat-related eruption

  3. Scombrotoxin poisoning

  4. Stress-induced urticaria


  • scombrotoxin poisoning
  • scombroid
  • histamine fish poisoning

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.