Abstract
Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate after Amanita phalloides poisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options.
Highlights
Acute liver failure (ALF) can be caused by the ingestion of mushrooms containing exceptionally powerful hepatotoxins [1]
Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis
Amatoxin poisoning may progress into acute liver failure (ALF) and eventually death if liver transplantation is not performed
Summary
Acute liver failure (ALF) can be caused by the ingestion of mushrooms containing exceptionally powerful hepatotoxins [1]. The amatoxin syndrome is of primary importance because it accounts for about 90% of fatalities [2]. It is characterized by an asymptomatic incubation period followed by the gastrointestinal and hepatotoxic phases, leading eventually to multiorgan failure and death. Amatoxin poisoning is caused by mushroom species belonging to three genera Amanita, Galerina, and Lepiota, with the majority of the fatalities attributable to Amanita phalloides, commonly known as the death cap [3] (Figure 1). Being the most common and deadly cause of mushroom poisoning, the present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to Amanita phalloides intoxication
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