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Amanita virosa induced toxic hepatitis: report of three cases
1Department of Clinical Pathology, Yonsei University College of Medicine, Seoul, Korea.
Abstract:
We report here three cases of Amanita virosa induced toxic hepatitis. Two of the three cases recovered but the other died 10 days after mushroom ingestion. Since the mortality of Amanita mushroom induced toxic hepatitis is very high, prompt diagnosis and aggressive therapeutic measures should be initiated as soon as possible. Our cases showed that the initial serum aminotransferase levels might not predict the clinical outcome of the patient, but that the prothrombin time (PT) seemed to be a more useful prognostic marker. Close monitoring of aminotransferase levels and PT as well as appropriate therapy are recommended. All three cases showed signs of proteinuria and we were able to characterize mixed tubular and glomerular type proteinuria at 3 or 4 days after ingestion in two cases. Among the previously reported Korean cases of suspected Amanita induced toxic hepatitis, most species could not be identified except for four cases of Amanita virosa. No cases of Amanita phalloides induced toxic hepatitis have been identified in Korea so far.
Insights
Amanita virosa mushroom ingestion caused toxic hepatitis in three patients. Prothrombin time (PT) is a better predictor of outcomes than aminotransferase levels for this severe liver injury.
Area of Science:
- Toxicology
- Hepatology
- Mycology
Background:
- Amanita virosa mushroom ingestion can lead to severe toxic hepatitis.
- Prompt diagnosis and aggressive treatment are crucial due to high mortality rates.
Observation:
- Three cases of Amanita virosa induced toxic hepatitis were reported.
- Two patients recovered, while one died 10 days post-ingestion.
- All patients exhibited proteinuria, with two showing mixed tubular and glomerular types.
Findings:
- Initial serum aminotransferase levels were not reliable predictors of clinical outcome.
- Prothrombin time (PT) emerged as a more useful prognostic marker.
- Amanita virosa is the identified species in Korean toxic hepatitis cases, unlike Amanita phalloides.
Implications:
- Close monitoring of aminotransferase levels and PT is recommended for patients with suspected Amanita mushroom poisoning.
- Early identification of prognostic markers like PT can guide aggressive therapeutic measures.
- Understanding the specific Amanita species involved is important for accurate diagnosis and treatment in different regions.