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

• Autor(a) principal: Garcia, Juliana
• Data de Publicação: 2015
• Outros Autores: Costa, Vera M., Costa, Ana Elisa, Andrade, Sérgio, Carneiro, Ana Cristina, Conceição, Filipe, Paiva, José Artur, Pinho, P. Guedes de, Baptista, Paula, Bastos, Maria de Lourdes, Carvalho, Félix
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10198/16113
• topic: Amanita pantherina; Amanita phalloides; Amatoxins; Intoxication; Isoxazoles; Wild mushrooms

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.