Wild-mushroom intoxication — Clinical case

Background: The growing use of wild mushrooms in culinary has led to an increase incidence of mushroom poisoning. Depending on the type of the mushroom, the adverse effects range from mild gastrointestinal symptoms to major cytotoxic effects resulting in organ failure and death. Methods and results: The authors report a case of a 63-year-old male, with past medical history of atrial fibrillation and hypertension, admitted at our hospital with nausea, vomiting and diarrhea with an evolution of two days evolution, after ingesting wild-mushrooms. There was no history of ingestion of other potential hepatotoxic drugs. On admission he was stable hemodynamically, presenting with abdominal pain. Liver function tests were elevated and hepatic virology was negative. With progressive hepatic damage indicated by persistent increase of aspartate aminotransferase and alanine aminotransferase, he was transferred to an Intensive Care Unit. The management consisted of intravenous hydration, and administration of silibinin and N-acetylcysteine. There was clinical improvement with progressive normalization liver function without the need for transplantation. Conclusion: In Portugal there is a traditional culture of picking and consumption of wild mushrooms especially in rural areas. Ingestion of potentially poisonous mushrooms occurs frequently, it typically results from misidentification but serious toxicity is uncommon. There are about twelve groups of identified mushroom toxins and fourteen described clinical syndromes. We present a clinical case of hepatotoxic syndrome as a profile presentation and therapeutic options available.