Main content area

Co-ingestion of amatoxins and isoxazoles-containing mushrooms and successful treatment: A case report

Garcia, Juliana, Costa, Vera M., Costa, Ana Elisa, Andrade, Sérgio, Carneiro, Ana Cristina, Conceição, Filipe, Paiva, José Artur, de Pinho, Paula Guedes, Baptista, Paula, de Lourdes Bastos, Maria, Carvalho, Félix
Toxicon 2015 v.103 pp. 55-59
Amanita pantherina, absorption, acetylcysteine, activated carbon, alpha-amanitin, blood pressure, case studies, females, gas chromatography-mass spectrometry, gastric juice, high performance liquid chromatography, hospitals, hypertension, ingestion, mushrooms, patients, poisoning, risk, therapeutics, toxicity, urine, Portugal
Mushroom poisonings occur when ingestion of wild mushrooms containing toxins takes place, placing the consumers at life-threatening risk. In the present case report, an unusual multiple poisoning with isoxazoles- and amatoxins-containing mushrooms in a context of altered mental state and poorly controlled hypertension is presented. A 68-year-old female was presented to São João hospital (Portugal) with complaints of extreme dizziness, hallucinations, vertigo and imbalance, 3 h after consuming a stew of wild mushrooms. The first observations revealed altered mental state and elevated blood pressure. The examination of cooked mushroom fragments allowed a preliminary identification of Amanita pantherina. Gas chromatography–mass spectrometry (GC–MS) showed the presence of muscimol in urine. Moreover, through high-performance liquid chromatography-ultraviolet detection (HPLC-UV) analysis of the gastric juice, the presence of α-amanitin was found, showing that amatoxins-containing mushrooms were also included in the stew. After 4 days of supportive treatment, activated charcoal, silybin and N-acetylcysteine, the patient recovered being discharged 10 days post-ingestion with no organ complications. The prompt and appropriate therapy protocol for life-threatening amatoxins toxicity probably saved the patient's life as oral absorption was decreased and also supportive care was immediately started.