Three cases of mushroom poisoning with an unexpected initial presentation: acute kidney injury with Amanita proxima poisoning

Abstract

Background

Mushroom poisoning causes common gastrointestinal symptoms such as nausea and vomiting and is a well-known reason for acute hepatic failure. Acute kidney injury is a less common clinical presentation in mushroom poisoning. Recently, nephrotoxicity called Amanita nephrotoxic syndrome has been defined, caused by several Amanita mushrooms. It is characterized by moderate hepatotoxicity and oligoanuric acute kidney injury, which may require hemodialysis.

Case presentation

Case 1 was a 51-year-old female patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed pulmonary hemorrhage during her follow-up. Case 2 was a 55-year-old male patient who was hospitalized with anuria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed acute coronary syndrome during his follow-up. Case 3 was a 59-year-old male patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed moderate hepatotoxicity during his follow-up. All cases were hospitalized at the same time interval with similar clinical features. Acute kidney injury was the initial presentation of all the cases, and they had only mild transaminase elevation with normal INR levels. They all required hemodialysis, and kidney injury was fully recovered.

Conclusions

Mushroom consumption must be questioned in acute kidney injury patients of unknown etiology where mushrooms are habitual despite deleterious consequences.