Amatoxin Poisoning: Case Reports and Review of Current Therapies

BackgroundDiagnosis and management of Amanita mushroom poisoning is a challenging problem for physicians across the United States. With 5902 mushroom exposures and two resultant deaths directly linked to Amanita ingestion in 2009, it is difficult for physicians to determine which patients are at risk for lethal toxicity. Identification of amatoxin poisoning can prove to be difficult due to delay in onset of symptoms and difficulty with identification of mushrooms. Consequently, it is difficult for the Emergency Physician to determine proper disposition. Further, treatment options are controversial.ObjectivesTo review current data to help health care providers effectively identify and treat potentially deadly Amanita mushroom ingestions.Case ReportsWe present two cases of Amanita mushroom ingestion in the northeastern United States treated with N-acetylcysteine, high-dose penicillin, cimetidine, and silibinin, a semi-purified fraction of milk thistle-derived silymarin, as part of their treatment regimen. The mushroom species was identified by a consultant as Amanita Ocreata.ConclusionsWe present the successful treatment of 2 patients who ingested what we believe to be an Amanita species never before identified in the northeastern United States.