A Patient’s Journey
Irreversible renal damage from accidental mushroom poisoning
Cite this as: BMJ 2012;345:e5262
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The experience of Nicholas Evans highlights the importance of correct identification in the use of mushrooms for cuisine. Clearly in this case, the underlying cause of the progressive renal failure was quickly identified by thorough history-taking.
In our unit, we have had recent experience with renal toxicity caused by deliberate ingestion of Psilocybin mushrooms, utilised for their hallucinogenic effects. Acute renal failure secondary to the recreational use of mushrooms is infrequently reported. Raff et al. describe a case of Psilocybin toxicity; there are other small case reports on intoxication by similar psychoactive mushroom species, most notably Cortinarius . The evidence base is poor, but improvement with conservative management is the general trend. Whilst the majority of patients presenting with mushroom toxicity are likely to provide a comprehensive history, those using 'magic' mushrooms might understandably be more reticent with the details. Consequently, this should be a rare but important differential in patients with acute renal failure that cannot otherwise be explained by routine imaging and vasculitis screening.
1. Raff E, Halloran PF, Kjellstrand CM. Renal failure after eating "magic" mushrooms. CMAJ 1992;147(9):1339–1341.
2. Frank H et al. Acute renal failure by ingestion of Cortinarius species confounded with psychoactive mushrooms: a case series and literature survey. Clin Nephrol 2009;71(5):557-62.
Competing interests: None declared
West Suffolk Hospital, West Suffolk Hospital, Bury St Edmunds, IP33 2QZ
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In a nation of 62 million fungiphobes the incidence of fatal poisoning is extremely rare but as Nicholas Evans discovered the personal consequences of fungi misidentification are very difficult to bear. I am pleased that he, his brother in law and family members are now recovering.
I cited this case in my book Eat Wild (Two Rivers Press 2010) to reinforce the need for accurate identification. The book contains a warning that anyone who wishes to partake in this natural harvest must learn to accurately identify the things which they wish to eat. This identification must be absolute because there are several species of common fungi and plants which can be deadly. If in doubt, don't eat it. It is also a basic first step in fungi identification to check whether it is a gill, tube or spine spore species. Ceps have tubes under the cap but the deadly Cortinarius species eaten by Nicholas and his family quite clearly have gills so I find it hard to understand how such an elementary test was missed.
I was initially coached in my identification skills by Finns and later by members of the Thames Valley Fungus Group. However, with the increase of public exposure to our fantastic range of edible wild fungi through TV chefs and other popular formats, there is a possibility that more cases requiring hospitalization will occur. In France where about 20 deaths a year occur the pharmacies are responsible for public fungi identification. Whether that would be a welcome public health intervention here is debatable but it reinforces the need for personal responsibility and sensibility as well as adequate skills lest further distressing cases such as that experienced by Nicholas Evans and family become more regular occurrences.
Competing interests: Author of Eat Wild
NA, Twyford, Berkshire RG10 9PT
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