Mushroom Poisoning by Macrolepiota neomastoidea

There are currently over 5,000-known species of mushrooms worldwide. Only 20-25% of mushrooms have been named, and 3% of these are poisonous. More than 95% of mushroom poisoning cases occur due to difficulties associated with the identification of mushroom species. Most of the fatal mushroom poisoning cases recorded to date have been related to the Amanita species. Until now, a case of fatal poisoning caused by Macrolepiota neomastoidea (M. neomastoidea) has not been reported in Asia. A 57-year-old male patient was admitted to the emergency room with nausea, vomiting, diarrhea, and abdominal pain. He reported ingesting wild mushrooms with his mother and sister about 2 days ago. His mother and sister were treated with only supportive care, but he was admitted to the intensive care unit and underwent liver transplantation due to acute liver failure. We are reporting a case of fatal M. neomastoidea intoxication from wild mushrooms, a rare case of mushroom poisoning.

Prognostic value of decision criteria for emergency liver transplantation in patients with wild mushroom induced acute liver injury

BACKGROUND

The reported mortality rate of mushroom-induced acute liver failure with conventional treatment is 1.4%-16.9%. Emergency liver transplantation may be indicated and can be the only curative treatment option. This study aimed to assess the prognostic value of criteria for emergency liver transplantation in predicting 28-day mortality in patients with mushroom-induced acute liver injury.

METHODS

A retrospective cohort study was performed between January 2005 and December 2015. All adult patients aged≥18 years admitted with mushroom intoxication at our emergency department were evaluated. All patients with acute liver injury, defined as elevation of serum liver enzymes (>5 times the upper limit of normal, ULN) or moderate coagulopathy (INR > 2.0) were included. The ability of the King's College, Ganzert's, and Escudié's criteria to predict 28-day mortality was evaluated.

RESULTS

Of the 23 patients with acute liver injury following mushroom intoxication, 10 (43.5%) developed acute liver failure and subsequently died. The mean time interval from ingestion to death was 11.3 ± 6.6 days. Eight patients fulfilled Ganzert's criteria, while 10 patients fulfilled the King's College and Escudié's criteria for emergency liver transplantation. King's College and Escudié's criteria had 100% accuracy in predicting 28-day mortality; however, Escudié's criteria were able to identify fatal cases earlier.

CONCLUSIONS

Escudié's criteria demonstrated the best performance with 100% accuracy and the ability to promptly identify fatal cases of mushroom-induced acute liver failure.