• Ying Li, Maoyuan Mu, Ling Yuan, Baimei Zeng, and Shide Lin.
• Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical College, Guizhou, China.
• Medicine (Baltimore). 2018 Jul 1; 97 (27): e11288.

RationaleAcute liver failure (ALF) induced by amatoxin-containing mushrooms accounts for more than 90% of deaths in patients suffering from mushroom poisoning. However, due to the fact that most hospitals cannot identify the species of mushrooms involved, or detect amatoxins, the early diagnosis of amatoxin intoxication remains a significant challenge in clinical practice.Patient ConcernsTwo patients were had ingested wild mushrooms 15 hours before admission. Six hours prior to admission they experienced nausea, vomiting, weakness, abdominal pain and diarrhea. The species of mushrooms they had consumed could not be identified.DiagnosesAccording to their delayed gastroenteritis, the two patients were clinically diagnosed with amatoxin poisoning. One week after the patients were discharged, the species of the mushrooms was identified as Amanita fuliginea and the diagnosis was confirmed.InterventionsThe two patients were treated with silibinin, penicillin G and plasma exchange.OutcomesAlthough the two patients progressed to ALF they fully recovered and were discharged on day 10 after admission.LessonsOur case reports suggested that patients with unidentified wild mushroom intoxication with delayed gastroenteritis could be clinically diagnosed with amatoxin poisoning; in such cases, liver coagulation function should be frequently evaluated. Early diagnosis and treatment are crucial for survival in patients with ALF induced by amatoxin poisoning.

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