CASE DETAIL


General Pathology  »   LIVER (XVIII)  »   Necrosis (vii)

MUSHROOM POISONING

Museum No: XVIII:vii:6   

Year: 1927

 

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Clinical data:

This patient was one of a family poisoned by eating mushrooms (Amanita sp.). He was semi-conscious with vomiting and severe abdominal pain, devleoped jaundice and died after 4 days. 

Macroscopy:

At autopsy, he was slightly jaundiced and haemorrhages were present in his lungs. His liver had a mottled appearance, resembling that of passive congestion.

Microscopy:

Microscopy showed very extensive centrilobular zonal necrosis, often with survival of only a narrow rim of parenchymal cells around the portal tracts.

Comments:

This case and those of all the family members who died in this tragic episode was reported in the Journal of the South African Medical Association, November 1927. The report includes the post-mortem notes of Prof JB Ryrie.

See also specimen  XVIII:vii:7 (Family member)

 

A recent collection of some 28018 mushroom poisonings worldwide between 1959-2002 described 14 major syndromes, stratified by presentation timing and by target organ toxicity; they were divided into early (< 6hrs), late (6 - 24 hrs) and delayed (> 1 day) syndromes. A triphasic onset of (i) subacute gastrointestinal toxicity followed by (ii) a false recovery period and then (iii) late hepatotoxicity is characteristic of cyclopeptide-containing mushrooms, which continue to be responsible for most fatalities and comprise species from one of three main genera Amanita, Galerina or Lepiota.

References:

James H Diaz. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005; 33:427-36.