A case study of Lepiota brunneoincarnata poisoning with endoscopic nasobiliary drainage in Shandong, China

• Published in: Toxicon (Oxford) Vol. 161; pp. 12 - 16
• Main Authors: Sun, Jian, Zhang, Hong-Shun, Li, Hai-Jiao, Zhang, Yi-Zhe, He, Qian, Lu, Jun-Jia, Yin, Yu, Sun, Cheng-Ye
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2019
• Subjects: Amatoxins; Endoscopic nasobiliary drainage; Lepiota brunneoincarnata; Poisoning; Poisoning; Endoscopic nasobiliary drainage; Lepiota brunneoincarnata; Amatoxins
• ISSN: 0041-0101; 1879-3150
• DOI: 10.1016/j.toxicon.2019.02.017

The most frequently reported fatal Lepiota ingestions are due to L. brunneoincarnata. We present a case of L. brunneoincarnata poisoning with endoscopic nasobiliary drainage known to be the first in China. The patient suffered gastrointestinal symptoms 9 h post ingestion of mushrooms. The patient was hospitalized 4 days after eating the mushrooms with jaundice. The peak ALT, AST, APTT, TBIL and DBIL values of the patient were as follow: ALT, 2980 U/L (day 4 post ingestion); AST, 1910 U/L (day 4 post ingestion); APTT, 92.8 seconds (day 8 post ingestion), TBIL, 136 μmol/L (day 10 post ingestion), DBIL 74 μmol/L (day 10 post ingestion). UPLC-ESI-MS/MS was used to detect the peptide toxins in the mushroom and biological samples from the patient. We calculated that the patient may have ingested a total of 29.05 mg amatoxin from 300 g mushrooms, consisting of 19.91 mg α-amanitin, 9.1 mg β-amanitin, and 0.044 mg γ-amanitin. Amatoxins could be detected in bile even on day 6 after ingestion of L. brunneoincarnata. With rehydration, endoscopic nasobiliary drainage and intravenous infusion of Legalon SIL, the patient recovered after serious hepatotoxicity developed. •This study is the first to systematically report a Lepiota brunneoincarnata poisonging case in China.•With endoscopic nasobiliary drainage and Legalon SIL, the patient recovered after ingestion of 0.38 mg/kg amatoxin.•Amatoxins could be detected in bile even on day 6 after ingestion of Lepiota brunneoincarnata.