Chan Tina Yee Ching, Ng Sau Wah, Chan Chi Keung, Lee Hencher Han Chih, Mak Tony Wing Lai
Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Kowloon, Hong Kong Special Administrative Region, China.
Hong Kong Poison Information Centre, United Christian Hospital, Kowloon, Special Administrative Region, China.
J Med Cases. 2023 Jun;14(6):222-226. doi: 10.14740/jmc4109. Epub 2023 Jun 29.
We report an uncommon case of cholinergic poisoning following an ingestion of wild mushrooms. Two middle-aged patients presented to the emergency unit with acute gastrointestinal symptoms including epigastric pain, vomiting and diarrhea, followed by miosis, palpitations and diaphoresis which were compatible with a cholinergic toxidrome. The patients volunteered a history of taking two tablespoons of cooked wild mushrooms collected in a country park. Mildly elevated liver transaminase was noted in one female patient. Mushroom specimens were sent to a mycologist for identification using morphological analysis. Muscarine, a cholinergic toxin found in mushrooms such as and species, was subsequently extracted from and identified in the urine specimens of both patients, using a liquid-chromatography tandem mass spectrometry method. In this report, the variable clinical presentation of cholinergic mushroom poisoning is discussed. Key issues in the management of these cases were presented. In addition to conventional mushroom identification methods, this report also highlights the use of toxicology tests on different biological and non-biological specimens for diagnosis, prognosis and surveillance purposes.
我们报告了一例因误食野生蘑菇导致的罕见胆碱能中毒病例。两名中年患者因急性胃肠道症状就诊于急诊科，这些症状包括上腹部疼痛、呕吐和腹泻，随后出现与胆碱能中毒综合征相符的瞳孔缩小、心悸和多汗。患者自述食用了两汤匙在郊野公园采集的煮熟野生蘑菇。一名女性患者的肝转氨酶轻度升高。蘑菇标本被送往真菌学家处，通过形态学分析进行鉴定。随后，使用液相色谱串联质谱法从两名患者的尿液标本中提取并鉴定出毒蕈碱，这是一种在某些蘑菇品种中发现的胆碱能毒素。在本报告中，讨论了胆碱能蘑菇中毒的不同临床表现。介绍了这些病例管理中的关键问题。除了传统的蘑菇鉴定方法外，本报告还强调了对不同生物和非生物标本进行毒理学检测以用于诊断、预后和监测的用途。
