Recovery from severe hepatitis caused by mushroom poisoning without liver transplantation

Toxic mushroom poisoning leads to a variety of clinical outcomes ranging from self-limited gastrointestinal symptoms to fulminant hepatic failure requiring orthotopic liver transplantation. We reviewed the outcomes of patients with severe acute hepatitis secondary to mushroom poisoning, treated with contemporary modalities.

We retrospectively reviewed patients admitted to our institution over a 5-year period with elevated transaminase levels (>1000 IU/L) attributed to recent mushroom ingestion. The patients' clinical course, laboratory data, and treatment regimen were recorded and analyzed.

Eight patients who presented with severe hepatitis after mushroom ingestion qualified for analysis. The mean peak serum levels were: aspartate transaminase 5488 IU/L, alanine transaminase 7618 IU/L, and total bilirubin 10.5 mg/dL. The mean peak prothrombin time was 31 seconds. One patient developed acute renal failure requiring hemodialysis. Three patients developed encephalopathy ranging from grade I to III. All 8 patients survived without significant morbidity or need for liver transplantation. Subgroup analysis revealed that older patients spent more days in the intensive care unit and subsequently had longer hospital stays. The older group also had a trend toward more severe laboratory abnormalities.

Patients with severe hepatitis from mushroom poisoning are thought to have a poor prognosis and frequently need liver transplantation for survival. We suggest that with early and aggressive multidisciplinary care, such patients have improved outcomes and may avoid liver transplantation.