Wild mushroom poisoning: a case series from Nepal highlighting diverse clinical presentation, management challenges,...

Yearly, hundreds of people are hospitalized due to mushroom poisoning, and the mortality rate is high due to a variety of reasons, such as delayed presentation, diverse and complex clinical symptoms, and a lack of well-defined clinical guidelines for management.

In June 2023, husband and wife (Case 1 and Case 2) unknowingly consumed wild mushrooms and were admitted after 4 days with a diagnosis of Hyperacute liver failure. Both of them were treated with N-acetyl cysteine (NAC), silymarin, and other supportive measures, including intravenous hydration along with correction of electrolyte abnormalities. Case 1 was successfully managed and was discharged with normal lab values. Whereas, Case 2 deteriorated and underwent disseminated intravascular coagulation, causing mortality. Another case (Case 3) presented with minimal symptoms and was managed supportively for 1 day, and didn't have any adverse outcomes.

Clinical presentation of Amanita poisoning may vary from asymptomatic to life-threatening acute liver failure. NAC, Silymarin, along with other supportive measures, are being seen as promising treatment options in resource-limited settings where urgent liver transplantation facilities are limited. Even with appropriate treatment, the course and prognosis are generally unpredictable.

Amanita mushroom poisoning has a diverse and complex presentation. Despite a lack of concrete guidelines on management, measures like NAC, Silymarin, and other supportive management, like intravenous hydration and correction of electrolyte abnormalities, have shown promising results in cases of delayed presentation and limited liver transplantation facilities.