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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Cardiac arrhythmias and cardiac arrest related to mushroom poisoning: A case report
Shu Li, Qing-Bian Ma, Ci Tian, Hong-Xia Ge, Yang Liang, Zhi-Guo Guo, Cheng-Duo Zhang, Bei Yao, Jia-Ning Geng, Fran Riley
Shu Li, Qing-Bian Ma, Ci Tian, Hong-Xia Ge, Yang Liang, Zhi-Guo Guo, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
Cheng-Duo Zhang, Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
Bei Yao, Department of Laboratory Medicine, Peking University Third Hospital, Beijing 100191, China
Jia-Ning Geng, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China
Fran Riley, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, United States
Author contributions: Li S and Tian C carried out the initial diagnosis and resuscitation; Ma QB, Ge HX, Liang Y, Guo ZG, and Tian C also played essential roles in providing critical healthcare throughout the hospital stay and clinical follow-up of the patient; Geng JN performed genome analysis of the mushrooms; Ma QB and Li S conceived the idea of possible publication of the case; Li S and Riley F were major contributors in the literature research and in the process of writing the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for anonymized information to be published in this article.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Bian Ma, MD, Associate Professor, Chairman, Chief Physician, Department of Emergency Medicine, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, China.
maqingbian@bjmu.edu.cn
Telephone: +86-10-82266699 Fax: +86-10-82264019
Received: May 10, 2019
Peer-review started: May 14, 2019
First decision: June 12, 2019
Revised: June 14, 2019
Accepted: June 26, 2019
Article in press: June 27, 2019
Published online: August 26, 2019
Processing time: 107 Days and 20.5 Hours
BACKGROUND
Mushroom exposure is a global health issue. The manifestations of mushroom poisoning (MP) may vary. Some species have been reported as rhabdomyolytic, hallucinogenic, or gastrointestinal poisons. Critical or even fatal MPs are mostly attributable to Amanita phalloides, with the development of severe liver or renal failure. Myocardial injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported, while cardiac arrhythmia or cardiac arrest is not commonly seen.
CASE SUMMARY
We report a 68-year-old woman with MP who suffered from delirium, seizure, long QT syndrome on electrocardiogram (ECG), severe cardiac arrhythmias of multiple origins, and cardiac arrest. She was intubated and put on blood perfusion. Her kidney and liver functions were intact; creatine kinase-MB was mildly elevated, and then fell within normal range during her hospital stay. We sent the mushrooms she left for translation elongation factor subunit 1α, ribosomal RNA gene sequence, and internal transcribed spacer sequence analyses. There were four kinds of mushrooms identified, two of which were found to be toxic.
CONCLUSION
This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea, which were believed to be toxic to the liver, kidney, and brain. We suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients, even without the development of severe liver or renal failure. The mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.
Core tip: Critical or even fatal mushroom poisonings are mostly attributable to Amanita phalloides, with severe liver or renal failure developing. Myocardial injury was reported previously while cardiac arrhythmias of multiple origins or cardiac arrest are definitely rarely seen or reported in the literature. Also, this is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea, which were believed to be hepatic, renal, and brain toxic.
