Severe scombroid poisoning complicated by distributive shock, acute respiratory distress syndrome and Kounis syndrome: a case report

Scombroid syndrome is a histamine-induced foodborne illness that can mimic anaphylaxis. Although typically self-limiting, scombroid syndrome can, in rare cases, lead to severe complications. The uniqueness of this clinical case lies in the unusually severe presentation of scombroid syndrome, which typically follows a benign course. This is particularly noteworthy given the concurrent presence of severe respiratory symptoms, shock, and Kounis syndrome. We present a case of a 59-year-old woman who developed severe scombroid poisoning after ingesting improperly stored canned tuna. Her presentation was complicated by distributive shock, acute respiratory distress, and ECG changes suggestive of Kounis syndrome. Management required high-dose intravenous epinephrine, non-invasive ventilation, and intensive hemodynamic monitoring. Coronary CT angiography later excluded obstructive coronary disease. This case highlights the potential severity of scombroid syndrome, its overlap with allergic coronary syndromes, and the diagnostic challenges they pose. Prompt recognition and tailored therapy are essential. Clinicians should be aware that improperly stored fish can precipitate life-threatening systemic reactions, requiring management beyond standard antihistamine treatment.