Muscimol. Amanita pantherina. VI. Psilocybin-containing mushrooms. Psilocybe caerulipes. Psilocybin. Psilocybe cubensis. Psilocin. Gymnopilus spectabilis.
å¡ CASE REPORT å¡
Delayed Onset Acute Renal Failure Associated with Amanita pseudoporphyria HongoIngestion Yoichi IWAFUCHI, Takashi MORITA*, Hideyuki KOBAYASHI, Kensaku KASUGA, Kazuhisa ITO, Osamu NAKAGAWA,Kaoru KUNISADA, Shigeru MlYAZAKI** and Akira KAMIMURA
smithiana.
Abstract
A 66-year-old manwith diabetes developed acute renal Case History failure after ingestion of Amanita pseudoporphyria Hongo. Laboratory data showed acute nonoliguric renal fail- In October 2000, a 66-year-old man was admitted; he had ure. A renal biopsy showed acute tubular necrosis with been well until several days before admission when he noglomerular minor abnormalities.
He received hemodialy-
ticed
general
fatigue,
facial
edema and appetite
loss.
Six
sis treatment for 3 weeks and his renal function normal- months before admission his renal function was normal and ized 2 months after admission. Wediscuss the differences urinary protein was negative. Twoweeks before admission in acute renal failure
caused by possible
toxins
of he picked two mushroomsof Amanita pseudoporphyria
Amanita pseudoporphyria Hongo from that caused by Hongo (Fig. 1) with other absolutely edible mushrooms and ate them. Nobody else ate the mushroom except for him. He other poisonous mushrooms. was aware of severe fatigue from the following day, but (Internal Medicine 42: 78-81, 2003) Key words: acute renal failure, Amanita pseudoporphyria Hongo, mushroompoisoning, nephrotoxin, allenic norleucine (2-amino-4, 5-hexadienoic acid)
there were no severe gastointestinal symptoms.Onthe day of admission, he was seen by a physician and pretibial edema and renal failure (creatinine 18.0 mg/dl) were pointed out. He had a ten-year history
of diabetes,
and he had taken
glibenclamide for five years, but recently he had not taken any other drugs before the occurrence of the abnormal findings. Introduction
On examination his blood pressure was 186/80 mmHg, pulse 82/min, temperature was 37.4°C. He had gained 5 kg Severe acute renal failure caused by mushroompoisoning in weight in the previous four weeks. Hewas not anemic nor is rare in Japan. Nephrotoxicity is most commonlyreported icteric. His heart and lungs were normal, and lymph nodes due to amatoxin poisoning in Japan as well as in Europe and were not palpable. No exanthema was observed but moderate North America. In Europe delayed onset renal failure caused peripheral edema was present. No neurological abnormalities by orellanine poisoning has also been reported. Recently in werenoted. the Pacific Northwest, Amanita smithiana has been reported Urinalysis showed a 1+ test for protein, a 1+ test for gluto contain other nephrotoxinsand several cases of acute renal cose and a 1+ test for occult blood; sediment showed 3-5 failure have been reported following ingestion of the mush- erythrocytes, 3-5 leukocytes, and 5-10 hyaline casts per room. Amanita smithiana is possibly being mistaken for the high-power field. Urinary protein was 0.2 g/24 hour and glupopular matsutake, or "pine mushroom"Tricholoma magni- cose was 1.5 g/24 hour. The urine p2 microglobulin level velare, to which it bears a superficial resemblance. was 20,640 mg/dl. Stool and urine cultures were negative. Wedescribe the first case report with delayed onset acute Hematocrit was 36.2%, the hemoglobin concentration was renal failure after ingestion of Amanita pseudoporphyria 13.5 g/dl; the platelet count was 157,000/mm3, and the leukoHongo that contains the same nephrotoxin as Amanita cyte count was 9,200/mm3.The serum urea nitrogen level From the Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, *the Department of Pathology, Shinrakuen Hospital, Niigata and **the Department of Internal Medicine, Kidney Center, Shinrakuen Hospital, Niigata Received for publication June 17, 2002; Accepted for publication December 2, 2002 Reprint requests should be addressed to Dr. Yoichi Iwafuchi, the Department of Internal Medicine, Koseiren Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo
78
955-0055
Internal
Medicine Vol. 42, No. 1 (January 2003)
%
ARFDue to MushroomPoisoning
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