Document Type : Case Report
Authors
1 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
Introduction: Mushroom poisoning remains a global concern, with over 5,000 species of poisonous mushrooms worldwide. Amanita phalloides is responsible for approximately 95% of fatal poisonings globally. Although most cases typically present with mild gastrointestinal symptoms, complications such as acute pancreatitis are rare yet critical, warranting a deeper exploration into their implications and management.
Case Presentation: We report a case of acute pancreatitis in a 45-year-old Iranian woman at Emam Reza Hospital, Mashhad, Iran, in November 2024 after possible consumption of Amanita mushrooms approximately 6 hours before her presentation to the medical facility. The patient, who had no significant medical or family history of pancreatic disease, presented with acute upper abdominal pain, nausea and vomiting. Examination and subsequent laboratory tests confirmed acute pancreatitis, characterized by markedly elevated amylase and lipase enzyme levels. She was treated with aggressive hydration and total parenteral nutrition, which resulted in remarkable clinical improvement within 6 days.
Discussion: While it is acknowledged that most cases of mushroom poisoning lead to mild gastroenteritis, the occurrence of acute pancreatitis as a secondary complication following mushroom ingestion remains strikingly underreported. This phenomenon, although rare, has recently garnered attention in clinical discourse, as evidenced by several case studies that have illuminated the relationship between certain mushroom toxins and pancreatic injury. It is vital for clinicians to consider pancreatitis as a potential complication in cases involving mushroom poisoning, thereby allowing for prompt diagnosis and management.
Conclusion: In light of the severe implications associated with acute pancreatitis secondary to mushroom poisoning, further research is imperative to elucidate the precise mechanisms linking mushroom toxins to pancreatic damage. This research would underscore the importance of clinician vigilance during diagnosis, as well as the necessity for public education aimed at preventing mushroom-related illnesses.
Keywords
Main Subjects
- Wennig R, Eyer F, Schaper A, Zilker T, Andresen-Streichert H. Mushroom Poisoning. Dtsch Arztebl Int. Oct 16 2020;117(42):701-8. doi:10.3238/arztebl.2020.0701
- Janatolmakan M, Ganji MR, Ahmadi-Jouybari T, Rezaeian S, Ghowsi M, Khatony A. Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran. BMC Pharmacol Toxicol. Sep 26 2022;23(1):72. doi:10.1186/s40360-022-00614-1
- Karahan S, Erden A, Cetinkaya A, Avci D, Ortakoyluoglu AD, Karagoz H, et al. Acute Pancreatitis Caused By Mushroom Poisoning: A Report of Two Cases. J Investig Med High Impact Case Rep. Jan-Mar 2016;4(1):2324709615627474. doi:10.1177/2324709615627474
- Caré W, Bruneau C, Rapior S, Langrand J, Le Roux G, Vodovar D. [Amatoxin-containing mushroom poisoning: An update]. Rev Med Interne. Nov 8 2023;Syndrome phalloïdien: mise au point. doi:10.1016/j.revmed.2023.10.459
- Enjalbert F, Rapior S, Nouguier-Soulé J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715-57. doi:10.1081/clt-120014646
- Soltaninejad K. Outbreak of Mushroom Poisoning in Iran: April-May, 2018. Int J Occup Environ Med. Jul 2018;9(3):152-56. doi:10.15171/ijoem.2018.1380
- Dadpour B, Tajoddini S, Rajabi M, Afshari R. Mushroom Poisoning in the Northeast of Iran; a Retrospective 6-Year Epidemiologic Study. Emerg (Tehran). 2017;5(1):e23.
- Barbosa I, Domingues C, Ramos F, Barbosa RM. Analytical methods for amatoxins: A comprehensive review. J Pharm Biomed Anal. Aug 5 2023;232:115421. doi:10.1016/j.jpba.2023.115421
- Karlson-Stiber C, Persson H. Cytotoxic fungi--an overview. Toxicon. Sep 15 2003;42(4):339-49. doi:10.1016/s0041-0101(03)00238-1
- Mottram AR, Lazio MP, Bryant SM. Lepiota subincarnata J.E. Lange induced fulminant hepatic failure presenting with pancreatitis. J Med Toxicol. Jun 2010;6(2):155-7. doi:10.1007/s13181-010-0062-1
- Silakhori S, Dadpour B, Najaf Najafi M. A 3-Year Survey of Mushroom-Poisoned Patients: Clinical Features, Management and Outcomes. Asia Pac J Med Toxicol, 2018; 7(2): 33-37. doi: 10.22038/apjmt.2018.1134