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Toxicon. 2015 Sep;103:55-9. doi: 10.1016/j.toxicon.2015.06.012. Epub 2015 Jun 16.

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

Author information

1
UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal. Electronic address: jugarcia_18@hotmail.com.
2
UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal.
3
Internal Medicine Service, São João Hospital Center, 4200-319 Porto, Portugal.
4
Intermediate Care Unit of Emergency Service, São João Hospital Center, 4200-319 Porto, Portugal.
5
CIMO/School of Agriculture, Polytechnic Institute of Bragança, Campus de Santa Apolónia, Apartado 1172, 5301-854 Bragança, Portugal.
6
UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal. Electronic address: felixdc@ff.up.pt.

Abstract

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.

KEYWORDS:

Amanita pantherina; Amanita phalloides; Amatoxins; Intoxication; Isoxazoles; Wild mushrooms

PMID:
26091874
DOI:
10.1016/j.toxicon.2015.06.012
[Indexed for MEDLINE]

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