CBRNE - T-2 Mycotoxins Differential Diagnoses

Updated: Aug 08, 2023
  • Author: Chan W Park, MD, FAAEM; Chief Editor: Zygmunt F Dembek, PhD, MS, MPH, LHD  more...
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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