Abstract
Background/Objectives Overseas travellers may be predisposed to a number of medical illnesses. Language barriers, particularly pertaining to multilingual signage, can contribute to at-risk behaviours.
Methods The case of an overseas traveller who developed acute-onset cerebellar dysfunction, generalised weakness, and altered sensation is described.
Results A 67-year-old male presented to the emergency department with generalised weakness and vomiting of 3 hours in duration, which had been preceded by peripheral paraesthesia for 5 hours. He spoke only Mandarin and was from overseas, in Australia visiting his family. Examination revealed multidirectional nystagmus, subtle bilateral ptosis, marked bilateral upper limb dysmetria and heel-shin ataxia, with mild global upper limb weakness. Computed tomography and magnetic resonance imaging of the brain were unremarkable. History obtained with translation assistance revealed that the patient had caught, and then consumed, a whole pufferfish (10–12cm in length) at a local beach 2 hours prior to the onset of symptoms. On review of sample images, the likely culprit organism was identified as a Smooth Toadfish (Tetractenos Glaber). This species of pufferfish is known to contain tetrodotoxin. The patient was managed supportively and made a complete recovery.
Conclusion Overseas travellers may be exposed to environmental risks due to unfamiliarity with their new surroundings. At-risk exposures may include dietary and culinary activities. Signage warning travellers regarding environmental risks, where possible, should be visually apparent, as well as including multilingual instructions and clear images.
