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CBRNE - T-2 Mycotoxins Differential Diagnoses

  • Author: Chan W Park, MD, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
Updated: Mar 09, 2016

Diagnostic Considerations

Vesicant (mustard and lewisite) exposure

Onset of pain may mimic T-2 mycotoxin exposure.

To differentiate lewisite from T-2 mycotoxin exposure, test the skin and clothing for the arsenic component of lewisite.

Onset of dermal symptoms (blistering, pain) from mustard exposure typically is delayed.[15]

Staphylococcal enterotoxin B

Staphylococcal enterotoxin B may cause respiratory and GI symptoms, but the burning dermal and mucocutaneous symptoms are absent.[15]

Ricin intoxication

All symptoms for ricin intoxication are similar to T-2 mycotoxin with the exception of the painful dermal symptoms, which are not observed in ricin intoxication.[2]

Other considerations

Symptoms of T-2 mycotoxin exposure are radiomimetic; thus, one must consider radiation sickness in the differential diagnosis. Nausea and vomiting have a large differential diagnosis. Examine patients with these symptoms without any suggestion of toxin exposure for other more common etiologies. The patient who may be more suggestive of a toxin exposure is a high-profile individual (ie, government official) who is vomiting with oral or cutaneous symptoms.

Patients presenting long after the initial exposure who now may be manifesting symptoms of the second stage of ATA may need to be investigated for a malignant process causing bone marrow replacement. Skin and mucosal erythema, blistering, ulceration, and necrosis can be the manifestation of many systemic diseases, which need to be considered.

Differential Diagnoses

Contributor Information and Disclosures

Chan W Park, MD, FAAEM Adjunct Assistant Professor, Division of Emergency Medicine, Duke University Medical Center; Director of Simulation Medicine, Durham Veterans Affairs Medical Center

Chan W Park, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


Thomas M Stein, MD 

Thomas M Stein, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Michael R Melia, MD Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia

Michael R Melia, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Kevin Scott Koehler, MD Resident Physician, Department of Emergency Medicine, Naval Medical Center Portsmouth

Disclosure: Nothing to disclose.

Chris Luttig, MD, MPH Resident Physician, Departments of Emergency Medicine and Internal Medicine, Virginia Commonwealth University Health System

Chris Luttig, MD, MPH is a member of the following medical societies: American College of Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Jerry L Mothershead, MD Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians

Disclosure: Nothing to disclose.


Michael P Allswede, DO Program Director, Disaster and Emergency Medicine Residency, Conemaugh Memorial Hospital; Director, Strategic Medical Intelligence, Inc

Disclosure: Nothing to disclose.

Lanny F Littlejohn, MD Staff Emergency Physician and Medical Director for Tactical Combat Casualty Care, Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia

Lanny F Littlejohn, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Special Operations Medical Association, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Donald A Locasto, MD Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Disclosure: Nothing to disclose.

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