Unrecognized magic mushroom abuse in a 28-year-old man

Area of Science:

• Toxicology
• Emergency Medicine
• Psychiatry

Background:

• A 28-year-old male with a history of substance abuse presented with recurrent, self-resolving symptoms over two months.
• The patient required extensive medical intervention, including multiple emergency department visits and hospital admissions.

Observation:

• Symptoms included altered mental status, vomiting, diaphoresis, and mydriasis.
• Extensive laboratory and imaging studies, including urine drug screening, were consistently negative.
• A definitive diagnosis remained elusive for emergency medicine, critical care, and consulting physicians.

Findings:

• The patient later admitted to using Psilocybe mushrooms.
• The constellation of symptoms, in the absence of other explanations, was attributed to Psilocybe mushroom toxicity.
• Diagnosis was based on clinical presentation and exclusion of other causes.

Implications:

• Considering Psilocybe mushroom toxicity early can improve resource utilization in emergency settings.
• This case underscores the importance of including mushroom abuse in the differential diagnosis for patients with unexplained symptoms.
• Educating emergency physicians about potential mushroom toxicity is crucial for timely and accurate diagnosis.