[Mixed amanita phalloides poisoning with rhabdomyolysis: analysis of 4 cases]

We report the clinical characteristics, treatments and outcomes of 4 rare cases of mixed amanita fuliginea and amanita rimosa poisoning with rhabdomyolysis, and review the research progress in the intoxication mechanism and treatment. The latent time of amanita poisoning, defined as the period from the ingestion of poisonous mushroom to the onset of gastrointestinal symptoms, was about 8 days, and the severity of poisoning was associated with the amount of mushroom ingested. All the 4 patients developed multiple organ dysfunctions within 3 to 4 days after mushroom ingestion, predominantly in the liver, kidney and central nervous system accompanied with acute gastrointestinal injury and rhabdomyolysis. The treatment measures included persistent hemofiltration and intermittent hemoperfusion once daily for 5-7 days, and plasma exchange was administered in 2 cases for 1 or 2 times. High-dose vitamin C, glucose and corticosteroid were also given to the patients. After the treatments, two patients were cured and the other two died due to an excess intake of poisonous mushroom and lack of early preemptive therapies. Early emetic, gastric lavage, catharsis, fluid infusion and diuresis are critical to interrupt the enterohepatic circulation of amanita phalloides toxins and prevent the development of multiple organ dysfunction. Enhanced hemofiltration and sequential plasma therapy might effectively eliminate toxin from the blood to protect against further organ damages.