Acute Kidney Injury Resulting from Amanita neoovoidea Intoxication

• Published in: Journal of Korean medical science Vol. 33; no. 38; pp. e230 - 3
• Main Authors: Lee, Jeong Ho, Kim, Sung Sun, Seok, Soon Ja, Bae, Eun Hui
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 17.09.2018; 대한의학회
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Aged; Amanita - pathogenicity; Creatinine - blood; Crystalloid Solutions - therapeutic use; Female; Fluid Therapy; Humans; Images i; Kidney - diagnostic imaging; Kidney - pathology; Male; Middle Aged; Mushroom Poisoning - complications; Mushroom Poisoning - diagnosis; Ultrasonography; 의학일반
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2018.33.e230

A 67-year-old man and his wife, a 63-year-old woman, were referred with elevated serum creatinine (s-Cr) levels. He had no known underlying disease and she had pre-existing hypertension and dyslipidemia, for which she was taking amlodipine 5 mg/day and rosuvastatin 10 mg/day. Three days prior, they ate wild mushrooms that looked like Tricholoma matsutake, which is very expensive in Korea. The next day, they developed generalized weakness, nausea, and loose stools. They firstly visited private clinics and received symptomatic treatment. However, the creatinine level of the couple was increased to 9.79 mg/dL in the man (normal range: 0.8–1.2 mg/dL) and 3.06 mg/dL in the woman. They did not complain of fever, chills, abdominal pain, or anuria. Acute kidney injury (AKI) was suspicious on ultrasonography findings in both. We performed renal biopsy and revealed tubular dilatation with tubular epithelial flattening, coagulative necrosis of the tubular epithelial cells with an intraluminal granular cast, and extensive regenerative changes (Fig. 1A) in the man. His wife's renal biopsy also showed acute tubular necrosis (ATN) with epithelial cell regeneration (Fig. 1B). Therefore, conservative treatment without RRT was continued with crystalloids 1–2 mL/kg/hr. On hospital day (HD) 4, s-Cr elevated at 11.4 mg/dL. After HD 4, his urine output increased to 3,000–4,000 mL/day and on HD 14, his creatinine level had improved to 2.4 mg/dL. His wife's lab values also normalized on HD 8. We asked a mycologist to get mushrooms from the mountains which the couple took the mushrooms and the leftover mushrooms in the patients' refrigerator. She identified them with Melzer's reagent and morphology as Amanita neoovoidea (Fig. 2) KCI Citation Count: 0