title: Co-ingestion of amatoxins and isoxazoles-containing mushrooms and successful treatment: A case report.
abstract: Mushroom poisonings occur when ingestion of wild mushrooms containing toxins takes place, placing the consumers at life-threatening risk. In the present case report, an unusual multiple poisoning with isoxazoles- and amatoxins-containing mushrooms in a context of altered mental state and poorly controlled hypertension is presented. A 68-year-old female was presented to São João hospital (Portugal) with complaints of extreme dizziness, hallucinations, vertigo and imbalance, 3 h after consuming a stew of wild mushrooms. The first observations revealed altered mental state and elevated blood pressure. The examination of cooked mushroom fragments allowed a preliminary identification of Amanita pantherina. Gas chromatography-mass spectrometry (GC-MS) showed the presence of muscimol in urine. Moreover, through high-performance liquid chromatography-ultraviolet detection (HPLC-UV) analysis of the gastric juice, the presence of α-amanitin was found, showing that amatoxins-containing mushrooms were also included in the stew. After 4 days of supportive treatment, activated charcoal, silybin and N-acetylcysteine, the patient recovered being discharged 10 days post-ingestion with no organ complications. The prompt and appropriate therapy protocol for life-threatening amatoxins toxicity probably saved the patient's life as oral absorption was decreased and also supportive care was immediately started.
authors.affiliation: UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal. Electronic address: jugarcia_18@hotmail.com.
authors.forename: Juliana
authors.initials: J
authors.lastname: Garcia
authors.affiliation: UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal.
authors.forename: Vera M
authors.initials: VM
authors.lastname: Costa
authors.affiliation: Internal Medicine Service, São João Hospital Center, 4200-319 Porto, Portugal.
authors.forename: Ana Elisa
authors.initials: AE
authors.lastname: Costa
authors.affiliation: Intermediate Care Unit of Emergency Service, São João Hospital Center, 4200-319 Porto, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Andrade
authors.affiliation: Intermediate Care Unit of Emergency Service, São João Hospital Center, 4200-319 Porto, Portugal.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Carneiro
authors.affiliation: Intermediate Care Unit of Emergency Service, São João Hospital Center, 4200-319 Porto, Portugal.
authors.forename: Filipe
authors.initials: F
authors.lastname: Conceição
authors.affiliation: Internal Medicine Service, São João Hospital Center, 4200-319 Porto, Portugal.
authors.forename: José Artur
authors.initials: JA
authors.lastname: Paiva
authors.affiliation: UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal.
authors.forename: Paula Guedes
authors.initials: PG
authors.lastname: de Pinho
authors.affiliation: CIMO/School of Agriculture, Polytechnic Institute of Bragança, Campus de Santa Apolónia, Apartado 1172, 5301-854 Bragança, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Baptista
authors.affiliation: UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal.
authors.forename: Maria
authors.initials: M
authors.lastname: de Lourdes Bastos
authors.affiliation: UCIBIO-REQUIMTE/Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua José Viterbo Ferreira nº 228, 4050-313 Porto, Portugal. Electronic address: felixdc@ff.up.pt.
authors.forename: Félix
authors.initials: F
authors.lastname: Carvalho
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000363:Agaricales / Q000737:chemistry*; D000368:Aged; D053959:Alpha-Amanitin / Q000032:analysis; D000545:Amanita / Q000737:chemistry; D000546:Amanitins / Q000008:administration & dosage / Q000633:toxicity*; D002606:Charcoal / Q000627:therapeutic use; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000633:toxicity*; D009145:Mushroom Poisoning / Q000175:diagnosis / Q000188:drug therapy; D000077385:Silybin; D012838:Silymarin / Q000627:therapeutic use
chemical_list: D053959:Alpha-Amanitin; D000546:Amanitins; D007555:Isoxazoles; D012838:Silymarin; D002606:Charcoal; D000077385:Silybin; C018207:amatoxin; D000111:Acetylcysteine
keywords: Amanita pantherina; Amanita phalloides; Amatoxins; Intoxication; Isoxazoles; Wild mushrooms