Eyer F, Felgenhauer N, Zilker T
Toxikologische Abteilung der II. Medizinischen Klinik, Klinikum rechts der Isar - Technische Universität München, München, Germany.
Dtsch Med Wochenschr. 2004 Jan 23;129(4):137-40. doi: 10.1055/s-2004-817606.
A 71-year-old previously healthy man consumed a mushroom meal containing Amanita phalloides, which he had confused with Agaricus campestris. Approximately 8 hours later, typical gastrointestinal symptoms began with copious loss of fluids. Treatment with penicillin G was initiated followed by a continuous silibinin infusion before the patient was transferred to our toxicological department. Other than a transient tachycardia and diffuse pain on abdominal palpation clinical examination was without abnormal findings.
Laboratory findings showed severe hepatic damage with 100-fold increased transaminases, elevation of serum creatinine, hyperbilirubinemia and a serious disturbance of coagulation. Infection with HIV, hepatitis- and CMV as well as pathogenic enteric bacteria and antibiotic-associated pseudo-membranous colitis were excluded. 11 days after the mushroom meal x-ray of abdomen showed a 6 cm dilatation of the small intestine and an 8 cm dilatation of the colon.
Although clinical condition and laboratory findings nearly fulfilled transplantation criteria, hepatic injury resolved during intensive care therapy. Intractable diarrhea, dilatation of the intestine on x-ray as well as other findings met criteria of toxic megacolon. Therapy with antibiotics and systemic steroids was ineffective, so the patient needed decompression by a catheter, which was placed by colonoscopy. 30 days after the serious amanita poisoning complicated by development of toxic megacolon, the patient's condition resolved without sequelae and he was discharged.
In addition the well known complications of amanita-poisoning, such as hepatic failure, encephalopathy and multi-organ failure, involvement of other organs like bone marrow, pancreas, kidney and gastrointestinal tract (except for the initial cholera-like gastroenteritis) are not well documented in the literature. Uncommon complications like toxic megacolon require an empirical approach.
一名71岁既往健康的男性食用了一顿含有毒鹅膏的蘑菇餐，他误将其认作洋蘑菇。约8小时后，出现典型的胃肠道症状，伴有大量体液流失。开始用青霉素G治疗，随后在患者转至我们的毒理学科室之前持续输注水飞蓟宾。除了短暂的心动过速和腹部触诊时的弥漫性疼痛外，临床检查未发现异常。
实验室检查结果显示严重肝损伤，转氨酶升高100倍，血清肌酐升高，高胆红素血症以及凝血严重紊乱。排除了HIV、肝炎和巨细胞病毒感染以及致病性肠道细菌感染和抗生素相关性假膜性结肠炎。食用蘑菇餐11天后，腹部X线显示小肠扩张6厘米，结肠扩张8厘米。
尽管临床状况和实验室检查结果几乎符合移植标准，但肝损伤在重症监护治疗期间得到缓解。顽固性腹泻、X线显示的肠道扩张以及其他表现符合中毒性巨结肠的标准。抗生素和全身用类固醇治疗无效，因此患者需要通过结肠镜放置导管进行减压。在严重的毒鹅膏中毒并发中毒性巨结肠30天后，患者病情痊愈，无后遗症，随后出院。
除了毒鹅膏中毒的常见并发症，如肝衰竭、脑病和多器官功能衰竭外，文献中关于其他器官受累，如骨髓、胰腺、肾脏和胃肠道（除了最初类似霍乱的肠胃炎）的记载并不充分。像中毒性巨结肠这样的罕见并发症需要采用经验性治疗方法。
