New Syndromes in Mushroom Poisoning

Abstract

Several new mushroom poisoning syndromes have been described since the early 1990s. In these syndromes, the onset of symptoms generally occurs >6 hours after ingestion. Treatment is mainly supportive. The syndrome induced by Amanita smithiana/proxima consists of acute tubulopathy, which appears earlier and does not have the same poor prognosis as the orellanine-induced syndrome. It has been described since 1992 in the US and Canada with A. smithiana; in France, Spain and Italy with A. proxima; and in Japan with A. pseudoporphyria. The responsible toxin is probably 2-amino-4,5-hexadienoic acid. The erythromelalgia syndrome has been described as early as the late 19th century in Japan and South Korea with Clitocybe acromelalga, and since 1996 in France and then Italy with C. amoenolens. Responsible toxins are probably acromelic acids identified in both species. Several cases of massive rhabdomyolysis have been reported since 1993 in France and 2001 in Poland after ingestion of large amounts of an edible and, until then, valuable species called Tricholoma equestre. These cases of rhabdomyolysis are associated with respiratory and cardiac (myocarditis) complications leading to death. Rhabdomyolysis with an apparently different mechanism was described in Taiwan in 2001 with Russula subnigricans. Finally, cases of encephalopathy were observed twice after ingestion of Hapalopilus rutilans in Germany in 1992 and Pleurocybella porrigens in Japan in 2004, where a convulsive encephalopathy outbreak was reported in patients with history of chronic renal failure.

Mycetism: A Review of the Recent Literature

“…Patients exhibited convulsions (78 %), myoclonus (47 %), dysarthria (31 %), ataxia (25 %), and paresis or paralysis (22 %) [46]. Intractable status epilepticus has also been reported [47][48][49]. MRI may reveal intracranial lesions involving the subcortical white matter of the insular cortex, claustrum, external capsule, putamen, and globus pallidus [48].…”

“…In Germany, encephalopathy and hepatorenal insufficiency associated with purple urine have been reported following ingestion of Hapalopilus rutilans (Purple Dye Polypore) [8,15,49]. Polyporic acid (2,5-diphenyl-3,6-dihydroxy-1,4-benzoquinone) may be responsible.…”

“…Neurological symptoms, such as vertigo, ataxia, drowsiness, hypotonia, and visual complaints, follow. Hepatorenal laboratory abnormalities have been reported [2,49]. P. porrigens (Angel's Wing), Grifola frondosa , and Pleurotus eringii poisonings may present with encephalopathy (see "Mitochondrial Toxins" section below).…”

“…Dipping the extremities in cold water often provides relief, while traditional analgesics may be ineffective. The syndrome can last for weeks to months [15,32,49,[62][63][64].…”

“…Mushrooms that produce rhabdomyolysis may produce myocarditis, cardiomyopathy, dysrhythmias, and cardiovascular collapse (see "Myotoxins" section below) [32,49,71,72]. A. phalloides ingestion rarely produces cardiogenic shock with ventricular systolic dysfunction and hypotension.…”