Abstract
We present the case of a 44-year-old female who presented with atraumatic avascular necrosis (AVN) of the patella and hips bilaterally, following ingestion of the deadly fungus Amanita phalloides or ‘death cap’ and subsequent liver transplant. Upon presentation, in the hours following ingestion, our patient required a liver transplant and ICU admission. She was treated by a multidisciplinary team, with input from various specialities. Our patient required steroids in the months following this event. Six months after the liver transplant and subsequent ICU admission, our patient developed hip pain, thus limiting her mobility, ability to engage in physiotherapy and rehabilitation. X-rays were performed that excluded any acute pathology. She was still receiving high-dose steroids at this time. When the pain did not resolve with analgesia, MRI of pelvis and knee was performed and the patient was found to have polyarticular AVN. Acute bilateral total hip replacement was performed and within weeks, the patient returned to physiotherapy and to full rehabilitation. Conservative management of the patella was favoured. Over two years later, the patient can now mobilise independently.The role of acute total hip replacement is evident in this case, and how in performing this surgery, the overall conditioning and health of our patient improved drastically. Currently, cases reporting A. phalloides ingestion are few and we wish to use this case to highlight the differential diagnosis in a patient presenting with joint pain in this context of fungus ingestion, organ transplant or prolonged steroid use.
Highlights
Amanita phalloides or ‘death cap’ is one of the most dangerous variants of fungi found in Western Europe and North America
We present the case of a 44-year-old female who presented with atraumatic avascular necrosis (AVN) of the patella and hips bilaterally, following ingestion of the deadly fungus Amanita phalloides or ‘death cap’ and subsequent liver transplant
Six months after the liver transplant and subsequent ICU admission, our patient developed hip pain, limiting her mobility, ability to engage in physiotherapy and rehabilitation
Summary
Amanita phalloides or ‘death cap’ is one of the most dangerous variants of fungi found in Western Europe and North America. A 44-year-old female presented to our institution with fulminant hepatic failure and subsequent multiorgan failure following ingestion of A. phalloides mushrooms She became bed-bound due to intractable lower limb pain after liver transplant and diffuse dermal necrosis requiring multiple skin grafts. Between six to eight hours later, the patient noted abdominal pain and associated vomiting. As XY continued to improve clinically, her recovery was aided by our multi-disciplinary team input Throughout this period, the patient noted a new onset of groin pain resulting in regression in her mobility. Yellow arrow identifies atrophic musculature; red arrow highlights areas of alternating hyper and hypointensity and serpiginous lines within the subchondral marrow of the medial and lateral femoral condyles; green arrow shows bone marrow heterogeneity. Despite complications post-transplant, she maintains good mobility and range of movement in her lower limbs
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