Delayed Treatment of Misdiagnosed Mushroom Poisoning: Do Organic Anion Transporting Polypeptide Substrates Matter?

Area of Science:

• Toxicology
• Pharmacology
• Hepatology

Background:

• Presents a case of a middle-aged male with pre-existing type 2 diabetes, hypertension, and coronary bypass who ingested wild mushrooms.
• Initial misdiagnosis as infectious enterocolitis led to delayed appropriate treatment.
• The patient developed hepatorenal syndrome, necessitating transfer to a specialized clinic.

Purpose of the Study:

• To describe a case of amatoxin poisoning complicated by drug-transporter interactions.
• To highlight the importance of considering drug interactions in patients with mushroom poisoning.
• To evaluate the efficacy of acetylcysteine and silymarin in treating severe amatoxin toxicity.

Main Methods:

• The patient received intravenous acetylcysteine (double regimen), oral silymarin (600 mg/d), and supportive care.
• Treatment was initiated after diagnosis of hepatorenal syndrome and severe liver dysfunction (MELD score 30).
• Simultaneous exposure to amatoxin and chronic cardiovascular medications (statins, beta-blockers, aspirin) was noted.

Main Results:

• The patient recovered within 10 days, with normalization of transaminases after 3 months.
• Demonstrated successful management of severe hepatorenal dysfunction secondary to mushroom poisoning.
• Underscored the potential for drug-transporter interactions between toxins and chronic medications.

Conclusions:

• Intravenous acetylcysteine and oral silymarin, combined with supportive therapy, can be effective in managing severe amatoxin poisoning.
• Understanding transporter-related drug interactions is crucial for optimizing treatment and improving survival in such cases.
• Further research into alternative inhibitors of amatoxin uptake and OATP substrates is warranted.