Poisoning by Amatoxin-Containing mushrooms in suburban New York Report of four cases

Abstract

We report four cases of poisoning with amatoxin-producing mushrooms in suburban Long Island. All occurred when amateur mushroom hunters picked mushrooms from neighboring lawns. Two patients presented 30 hours post ingestion with evidence of acute hepatic dysfunction. One survived, after treatment with charcoal and penicillin; the other, a 90-year-old woman with prior cardiac disease soon developed shock and subsequently died. The other two patients were admitted 18 hours after ingestion of Lepiota chlorophyllum and received prompt charcoal hemoperfusion. Both did well, although one had a mild elevation of transaminases. Although most reports of amatoxin poisoning originate in Europe, these cases confirm that amatoxin-producing mushrooms, including Lepiota chlorophyllum, may be found in northeastern American suburbs. Such patients who present prior to 24 hours after ingestion should receive charcoal hemoperfusion if a lethal dose (> 50 g of mushroom) has been eaten.

Profiling of Amatoxins and Phallotoxins in the Genus Lepiota by Liquid Chromatography Combined with UV Absorbance and Mass Spectrometry

“…Although species of Amanita , such as A. phalloides , A. verna , A. virosa , A. ocreata , and A. bisporigera , are the most notorious source of amatoxins and account for most fatal mushroom poisonings, deaths have also been attributed to the ingestion of amatoxin-containing species of Lepiota , a genus of small, saprobic mushrooms of worldwide distribution [6,7,8,9,10,11,12]. However, in contrast to Amanita , there have been relatively few analyses of the toxic peptide composition of Lepiota mushrooms, and to the best of our knowledge none using modern high resolution methods.…”

Amanita ibotengutake Intoxication Treated With Plasma Exchange

“…In most cases of mushroom intoxication, we can detect the species neither at the time of admission nor during hospitalization. Some cases have been reported where plasma exchange should have been undertaken when ingestion had occurred within 24 hours because sometimes fatal intoxications occur, such as Amanita phalloides , which contains the highly poisonous amatoxin (5). In the present case, the patient had chronic renal failure and it was supposed that the poisonous substances would remain in vivo for a considerable time.…”

Lepiota subincarnata J.E. Lange Induced Fulminant Hepatic Failure Presenting with Pancreatitis

“…Since that time, one fatal case of L. josserandii ingestion (New York) and three non-fatal cases of other Lepiota spp. (New York, Northern California) have been reported [7][8][9]. This case of L. subincarnata J.E.…”