Alimentary toxic aleukia with low-dose chronic ingestion can be caused by which toxin?

• A. Saxitoxin
• B. Tetrodotoxin
• C. Diacetoxyscirpenol T-2
• D. Aflatoxin

Answer: (C)

Alimentary toxic aleukia is linked to chronic, low-dose exposure to a Fusarium-produced trichothecene mycotoxin. The toxin involved is T-2 toxin, also known as diacetoxyscirpenol. T-2 toxin inhibits protein synthesis and damages rapidly dividing cells, leading to gastrointestinal injury and bone marrow suppression with leukopenia, which fits the pattern of this syndrome after prolonged low-level ingestion. In contrast, the other toxins are associated with different clinical pictures: saxitoxin and tetrodotoxin cause acute neurotoxic paralysis, and aflatoxin primarily causes liver injury and cancer risk rather than aleukia.