A RARE CAUSE OF AMATOXIN POISONING RESULTING IN LIVER TRANSPLANTATION AND DEATH

Background: Over 90% of fatal mushroom poisonings in the United States are caused by the ingestion of Amanita phalloides. We report the ingestion of a much lesser known amatoxin-containing mushroom for which there is one previous report of ingestion and death in this country. Case Report: A 62-year-old previously healthy woman from upstate New York made a meal of mushrooms she picked from her lawn. She developed nausea and diarrhea the next day but waited until 40 hours after the ingestion before seeking medical care. She was found to have elevated liver transaminases and was transferred to a regional poison treatment center where she rapidly developed fulminant hepatic failure and underwent liver transplantation. The postoperative course was complicated by ARDS, sepsis, and renal failure. The patient died 18 days after transplant. Samples collected from where the patient had picked the mushrooms included 3 known edible species and several small Lepiota which were later identified as Lepiota josserandii. The patient admitted having no knowledge of what species she had picked. Conclusion: Amanita phalloides and other amanitas are well known as causes of amatoxin poisoning. Some species of Galerina and Lepiota are also known to contain amatoxin but are less frequently encountered as toxic ingestions. This case represents only the second reported ingestion and death caused by Lepiota josserandii in this country.
Donnelly M, Brouxhon S, Schneider S, Wax P. Department of Emergency Medicine, University of Rochester Medical Center, Rochester, [...]