An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous MushroomPodostroma cornu-damae

Abstract

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

Two cases of incidental Podostroma cornu-damae poisoning

“…He developed nausea, vomiting, and fever within 3 hours of consumption. His lungs showed hemorrhagic and necrotic changes, and he died within 12 days due to multi-organ failure [ 9 ].…”

Toxicological analysis of satratoxins, the main toxins in the mushroom Trichoderma cornu-damae, in human serum and mushroom samples by liquid chromatography–tandem mass spectrometry

“…1), also called "poison fire coral" or "kaen-take" (in Japanese), is a deadly toxic mushroom native to East Asia, Southeast Asia and Oceania [1][2][3]. Poisoning cases involving T. cornu-damae have been reported [4][5][6][7][8][9][10][11] including fatal cases [4][5][6][7][8]11], and the main toxins in T. cornu-damae have been identified as trichothecene macrolides, specifically satratoxin H and its 12′-acetate, 13′-acetate and 12′,13′-diacetate ( Fig. 2) [12].…”

“…The macrolide moieties in the satratoxins may simply affect their toxicity by altering their hydrophobicity [12]. Trichothecenes act on serotonin-mediated neurons to induce severe vomiting, diarrhea, dehydration and hypotension as acute symptoms that usually appear within about 30 min [4,6,8,9,17]. They also strongly inhibit the activity of peptidyl transferase, which is an integral part of the 60S subunit of the ribosome, resulting in inhibition of protein synthesis, destruction of bone marrow, and dysfunction of the gastrointestinal mucosal epithelium and skin, where cell division is active [14,15].…”

“…Trichothecenes also stimulate the production of inflammatory cytokines [18]. Consequently, satratoxins can cause cytokine storm or endotoxic shock-like symptoms within a few days of ingestion, such as circulatory failure [4,6,8], multiple organ failure [4][5][6]8], renal failure [4][5][6]8], organ necrosis [4,6,8], and progressive severe respiratory distress from lung necrosis [4,5,8]. The severity of these endotoxic shock-like symptoms depends on the amount of T. cornu-damae ingested.…”

“…The severity of these endotoxic shock-like symptoms depends on the amount of T. cornu-damae ingested. If only a small amount is ingested, these symptoms are mild [7,9,10], but if a lethal amount is ingested, these symptoms are severe and can result in death [4][5][6][7][8]11]. Ingestion of 1 g of T. cornu-damae can be fatal for an adult male [4].…”