Abstract
Tricholoma equestre (hereinafter – T. equestre) is a common edible fungus that is considered to be toxic under certain conditions. Here, we report four cases of acute poisoning caused by T. equestre, including one lethal outcome in Lithuania between 2004 and 2013. In the severe case, fatigue, nausea without vomiting and muscle pain, profuse sweating without fever, and respiratory insufficiency occurred. Laboratory tests showed an elevation of creatine kinase (CK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Although clinical findings and laboratory tests support evidence of rhabdomyolysis, no renal insufficiency was observed. Significance of T. equestre in cardiac changes is feasible but remains unclear.
Highlights
We present four cases of rhabdomyolysis after ingestion of Tricholoma equestre
An acute respiratory insufficiency developed. His creatine kinase (CK) value reached 34600 IU/L, Alkaline phosphatase (ALP) increased to 534 IU/L, whereas AST and ALT values slightly decreased
Biochemical findings showed a significant increase of CK, AST and ALT values, and the mortality rate reached around 25% which is comparable to other studies [2, 8]
Summary
Case report 1 A 56-year-old man was hospitalised after having been eating a litre of boiled T. equestre three times a day for six days. Case report 3 A 55-year-old woman was hospitalised at the Centre of Toxicology after having been eating half a litre of T. equestre once a day for one week. The results revealed 15% prolonged QT and ischemical changes in lateral, inferior, and interseptal myocardium walls; no acute cardiac failure symptoms were observed. Case report 4 A 44-year-old man was hospitalised after having been eating a standard portion of T. equestre three times a day as a main dish for three days. His CK value reached 34600 IU/L, ALP increased to 534 IU/L, whereas AST and ALT values slightly decreased. On the sixth day after consumption of T. equestre the patient died from a heart attack He was treated with fluids, diuretics, penicillin and gentamycin, thiamine, antipyretics, oxigenotherapy, and adrenalin for resuscitation. It was known that the patient had no other diseases and did not take any medications or drugs, except alcohol, prior to the poisoning
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