Mistreated fish products ingestion can lead to a histaminergic illness known as Scombroid Syndrome (SS). The disease usually causes cutaneous rash, stomach cramps, nausea, vomiting, breathing disorder and further histamine-related symptoms. To date, however, SS has been disregarded among the potential triggers of acute coronary syndrome (ACS), in spite of prior published occasional case reports. In the present study we describe 3 consecutive patients presenting with signs and symptoms of ACS associated to SS. Two men and a woman with no history of coronary artery disease and food allergy were studied. Clinical characteristics, electrocardiographic presentation and outcomes are described. Non-ST-elevation myocardial infarction-like pattern was observed in all patients. The 2 men underwent unremarkable coronary angiography, whereas the woman was just monitored at emergency department. All individuals had uneventful follow-up. The present study confirms non-ST-elevation myocardial infarction-like ACS as a possible histaminergic toxic, not allergic, epiphenomenon of mistreated raw tuna fish ingestion, likely due to transient epicardial and/or microvascular coronary vasospasm.
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