2587

A 7-YEAR-OLD GIRL WITH FULMINANT HEPATIC FAILURE CAUSED BY AMANITA PHALLOIDES MUSHROOM POISONING

Nakano K, Hasui M, Kotera F, Nakano T, Ishihara R, Kobayashi Y

Department of Pediatrics, Kansai Medical University, Osaka, Japan

The interest in gathering and eating uncultivated mushrooms has been associated with an increase in incidence of serious mushroom poisonings, We report a case of fulminat hepatic failure caused by mushroom poisoning.

Case report: A 7-year-old girl and 57-year-old her father picked wild mushrooms and ate them parboiled. She developed frequent vomiting 12 hours after ingestion, and consulted our hospital. Consciousness was clear, and liver function tests were within normal limits. Twenty-four hours later, she developed watery diarrhea. On the fourth day after eating the mushrooms, she developed hepatic coma. Abnormal laboratory findings included a WBC count of 15,800,AST 7,098 U/L, ALT 8,862 U/L, LDH 6,492 U/L, CK 4,737 U/L, total bilirubin 6.1mg/dl, APTT 73.6sec, PT<10%, ammonia 168 δμg/dl. Vigorous treatments, including repeated administration of activated charcoals, plasma exchange and continuous hemodiafiltration were successful in reversing the coma and liver functions to normal. On the seventh day, consciousness was clear and she was discharged 16 days after eating mushrooms. Although her father was asymptomatic, he was admitted 5 days after the ingestion because of elevated transaminase levels (AST 2,149 U/L, ALT 3,590 U/L).

Conclusion: Differentiation between amanita phalloides mushroom poisoning and viral hepatitis is difficult. An accurate history taking is of paramount importance.