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Doctors Present Poisonous Mushrooms Test Cases at Conference

Mushrooms  Poisonous mushrooms like these pictured are common in many people's yards. Eating them can result in liver failure, liver transplant or death, according to Dr. Jacqueline Laurin, a transplant hepatologist at the Georgetown Transplant Institute.

May 23, 2012 – Management and outcomes surrounding an antidote given to patients who unwittingly ate poison mushrooms last year were presented by Georgetown doctors May 21 at Digestive Disease Week, an international medical meeting.

The patients were treated as part of a Georgetown University Medical Center (GUMC) research study.

Initially, doctors at MedStar Georgetown University Hospital (MGUH) gave the first patient, a Springfield, Va., man who arrived at the hospital with early stage liver failure from mushroom poisoning, an IV made from milk thistle seeds (silibinin).

He was transferred to MGUH from a local emergency room because in some cases, a liver transplant is necessary following amanitin poisoning.

Emergency Use

Though the investigational agent had not been approved for a clinical research at GUMC, Georgetown doctors were able to offer the IV antidote to the man under the FDA’s “emergency use” one-time exception.  

Dr. Jacqueline Laurin, a transplant hepatologist at the Georgetown Transplant Institute, a part of MGUH and GMUC, says mushroom or amanitin poisoning is serious business.

Deadly Problem

The initial clinical presentation of mushroom poisoning, Laurin says, mimics gastroenteritis in the form of nausea, vomiting, abdominal pain and diarrhea, followed by a period of apparent recovery.

But the recovery period is typically followed by the development of acute hepatitis and jaundice.

“Early recognition of mushroom ingestion as a cause of acute hepatitis is paramount to initiate treatment and hopefully preventing progression to acute liver failure, liver transplant or death,” Laurin says.

Anticipating Need

The doctors anticipated that more patients might surface because mushrooms were growing in the Washington, D.C., area in greater numbers than usual after a period of increased rainfall.

Because of the FDA’s rule on one-time emergency use of a drug not part of a clinical study, any future treatment with silibinin could only be given as part of a clinical study approved by the Institutional Review Board (IRB) through the medical center.

“We knew it wasn’t out of the realm of possibility that another person could show up with mushroom poisoning and without a study in place, we wouldn’t have the option of offering the silibinin,” Laurin explains.

When a second patient arrived at GMUH with mushroom poisoning days later, it prompted an emergency meeting of the IRB, which was already in the process of approving the silibinin protocol.

The IRB comprises clinical and non-clinical members from the Medical Center and MGUH, and is charged with protecting humans in research studies.

More Research Needed

Patients number three and four subsequently came in with mushroom poisoning, all within two weeks, and were treated with the same antidote at the hospital.

The cases and their outcomes were presented at Digestive Disease Week, which took place in San Diego May 19-22.

The conference is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

“While [our] results appear promising, we need to know much more about silibinin,” Laurin said. “I think we can point to this case series as a treatment success, but clearly more work and education needs to be done to reduce morbidity and death from amanitin poisoning.”

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