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Laetiporus
suiphureus
causing
visual
hallucinations
and
ataxia
in
a
child
Richard
Edward
Appleton,
MB,
MA,
MRCP
James
Emery
Jan,
MD,
FRCPC
Paul
Douglas
Kroeger
M
hushroom
ingestion
is
a
recognized
cause
of
accidental
poisoning
in
children.
Toxic
effects
on
the
central
nervous
system
(CNS)
are
common
and
include
dizziness,
halluci-
nations
and
coma.
In
North
America
Laetiporus
sulphureus
is
considered
to
be
safe
and
harmless.
However,
we
describe
a
young
child
who
had
visual
hallucinations
and
ataxia
after
eating
this
mushroom.
Case
report
In
August
1987
a
6-year-old
girl
was
found
to
be
clumsy
and
to
be
slurring
her
speech.
Her
eyes
appeared
glazed.
Hallucinations
developed
that
were
described
as
"lines
and
shapes
of
bright
colours".
One
particularly
frightening
hallucina-
tion
consisted
of
a
"yellow
and
orange
monster"
that
floated
toward
her.
She
subsequently
became
disoriented
but
did
not
complain
of
headache
or
nausea.
She
denied
substance
abuse,
and
her
home
contained
only
child-strength
acetaminophen
and
codeine.
There
had
been
no
recent
head
trauma.
The
other
family
members
were
well.
When
seen
at
the
local
hospital
the
patient
was
afebrile
and
ataxic.
She
continued
to
describe
visual
hallucinations.
Syrup
of
ipecac
was
given
on
the
assumption
that
she
had
ingested
some
drug
or
toxin.
The
vomitus
contained
pieces
of
an
uniden-
tifiable
white
substance.
No
further
examination
or
analysis
of
the
vomitus
was
undertaken.
The
results
of
blood
analysis
were
negative
for
ethanol,
acetaminophen,
phenobarbital
and
acetylsalicylic
acid.
The
patient's
perinatal
period
and
early
devel-
opment
had
been
normal.
Between
2
and
5
years
of
age
she
had
had
a
number
of
brief
generalized
seizures
associated
with
fever.
The
child
was
transferred
for
further
assess-
ment
to
British
Columbia's
Children's
Hospital,
From
the
Division
of
Neurology,
Department
of
Paediatrics,
University
of
British
Columbia,
and
the
Vancouver
Mycological
Society
Reprint
requests
to:
Dr.
Richard
Edward
Appleton,
Rm.
1D15,
Division
of
Neurology,
Department
of
Paediatrics,
British
Co-
lumbia's
Children's
Hospital,
4480
Oak
St.,
Vancouver,
BC
V6H
3
V4
Vancouver,
5
hours
after
the
onset
of
symptoms.
She
was
alert,
restless
and
disoriented
in
place
and
time.
Vomiting
had
stopped.
She
appeared
fright-
ened
but
no
longer
described
hallucinations.
The
temperature
was
37.7°C,
the
pulse
rate
120
beats/min,
the
respiratory
rate
25/min
and
the
supine
blood
pressure
115/70
mm
Hg.
There
was
no
rash
or
evidence
of
ticks
or
insect
bites.
The
pupils
were
dilated
and
reacted
sluggishly
to
light.
Her
speech
was
mildly
dysarthric.
Testing
of
the
rest
of
the
cranial
nerves
showed
no
abnormalities.
She
was
unable
to
stand
on
one
leg.
The
muscle
strength
was
normal,
but
muscle
tone
was
reduced
in
the
trunk
and
limbs.
The
muscle
stretch
reflexes
were
brisk
symmetrically
(grade
3+),
and
the
plantar
reflexes
were
flexor.
The
complete
blood
count,
the
serum
concen-
trations
of
urea
nitrogen,
creatinine,
electrolytes,
glucose,
calcium,
ammonia
and
lactate
(with
the
patient
fasting),
the
plasma
concentrations
of
amino
acids
and
the
results
of
liver
function
tests
were
normal.
Electroencephalography
revealed
mild
dysrhythmia
in
the
right
temporoparietal
region.
Noncontrast
computed
tomograms
of
the
head
appeared
normal.
Urinalysis
yielded
negative
results
for
drugs
and
organophosphate
insecticides.
The
girl
was
completely
recovered
by
the
next
morning,
about
20
hours
after
the
onset
of
symp-
toms.
Her
sister
subsequently
admitted
seeing
the
child
eat a
tree-growing
mushroom
about
1
hour
before
the
hallucinations
started.
A
large
piece
(10
X
8
X
1
cm)
had
been
broken
off
the
mushroom
and
could
not
be
found.
No
other
mushrooms
grew
in
the
garden,
and
no
fertilizers
or
insecti-
cides
had
been
used.
The
mushroom
was
identified
as
L.
sul-
phureus.
Gas
chromatographic
analysis
of
the
mushroom
and
the
patient's
urine
collected
12
hours
after
ingestion
gave
negative
results
for
known
hallucinogens.
Comments
A
number
of
mushrooms
are
known
to
have
toxic
effects
on
the
CNS:
dizziness,
disorientation,
euphoria,
hallucinations
and
convulsions
have
oc-
curred.'
-
L.
sulphureus
is
a
polyporoid
fungus;
it
is
also
48
CMAJ,
VOL.
139,
JULY
1,
1988
known
as
polyporus
sulphureus,
sulfur
shelf
and
the
chicken
mushroom.6'7
It
is
commonly
eaten
cooked
in
North
America.6'7
Nausea,
abdominal
pain
and
dizziness
have
rarely
been
described.8
However,
it
is
considered
to
be
inedible
in
Great
Britain,
where
a
few
cases
of
poisoning
have
been
reported.9
Side
effects
seem
to
depend
on
the
susceptibility
of
the
individual.
Gastrointestinal
discomfort
has
been
reported
in
some
cases
and
CNS
disorders
(e.g.,
dizziness
and
disorientation)
in
others.
L.
sulphureus
contains
the
alkaloids
hordenine,
N-methyltyramine
and
tyramine,
which
are
not
normally
hallucinogenic.9'10
Mushrooms
are
unpredictable.
Some
species
are
consistently
poisonous
but
cause
symptoms
of
differing
severity,
and
others
are
poisonous
only
when
eaten
raw
or
during
certain
seasons
or
stages
of
maturity.
In
addition,
environmental
factors
and
geographic
locations
may
affect
the
toxin
content
of
mushrooms.
People
are
also
unpredictable:
one
person
may
be
severely
poisoned
by
a
mushroom
that
has
no
effect
on
another.
Alcohol
and
certain
drugs
(e.g.,
hydroxychloroquine
and
monoamine
oxidase
inhibitors)
may
make
an
ordinarily
harm-
less
mushroom
toxic
in
some
cases."1
In
the
case
we
have
described,
the
mush-
room's
toxicity
was
most
likely
due
to
a
combina-
tion
of
factors:
the
patient's
age,
the
amount
ingested
and
the
fact
that
it
was
eaten
raw.
Such
a
situation
is
not
uncommon.
Therefore,
certain
un-
cultivated
mushrooms,
usually
listed
as
being
edi-
ble,
should
not
be
eaten
raw
by
a
young
child.
References
1.
Goldfrank
LR,
Bresnitz
EA:
Toxic
and
hallucinogenic
mush-
rooms.
In
Goldfrank
LR
(ed):
Toxicologic
Emergencies:
a
Comprehensive
Handbook
in
Problem
Solving,
A-C-C,
New
York,
1982:
85-92
2.
Lewis
WH,
Elvin-Lewis
MP:
Hallucinogens.
In
Medical
Botany:
Plants
Affecting
Man's
Health,
Wiley,
New
York,
1977:
410-411
3.
Ibid:
425-427
4.
Lincoff
GH,
Mitchel
DH:
Psilocybin-psilocin
(hallucinogen-
ic)
poisoning.
In
Toxic
and
Hallucinogenic
Mushroom
Poisoning.
A
Handbook
for
Physicians
and
Mushroom
Hunters,
Van
Nos
Reinhold,
New
York,
1977:
100-135
5.
Arena
JM:
General
consideration
of
poisoning.
In
Poison-
ing:
Toxicology,
Symptoms
and
Treatments,
4th
ed,
C C
Thomas,
Springfield,
Ill,
1979:
106-107
6.
Dickinson
C,
Lucas
J:
The
Encyclopedia
of
Mushrooms,
Putnam
Pub
Group,
New
York,
1979:
153
7.
Lincoff
GH:
The
Audubon
Society
Field
Guide
to
North
American
Mushrooms,
Knopf,
New
York,
1981:
468-469
8.
Lincoff
GH,
Mitchel
DH:
Gastrointestinal
irritants.
In
Toxic
and
Hallucinogenic
Mushroom
Poisoning.
A
Handbook
for
Physicians
and
Mushroom
Hunters,
Van
Nos
Reinhold,
New
York,
1977:
163-164
9.
Pegler
DN,
Watling
R:
British
toxic
fungi.
Bull
Br
Mycol
Soc
1982;
Apr:
71-75
10.
Schultes
RE,
Hofmann
A:
Plants
of
hallucinogenic
use.
In
The
Botany
and
Chemistry
of
Hallucinogens,
2nd
ed,
C
C
Thomas,
Springfield,
Ill,
1980:
110
11.
Arena
JM:
Poisonous
plants,
reptiles,
arthropods,
insects
and
fish.
In
Poisoning:
Toxicology,
Symptoms
and
Treat-
ments,
4th
ed,
C
C
Thomas,
Springfield,
Ill,
1979:
555
Meetings
continued
from
page
36
Nov.
20-23,
1988:
39th
Annual
Educational
and
Scientific
Meeting
of
the
Ontario
Public
Health
Association
Sheraton
Centre,
Toronto
Conference
Preregistration,
Ontario
Public
Health
Association,
102
Adelaide
St.
E,
Toronto,
Ont.
M5C
1K9;
(416)
367-3313
Jan.
14-21,
1989:
Emergency
Medicine
for
the
Family
Physician
Treasure
Island
Resort,
Grand
Cayman
Island,
WI
Continuing
Medical
Education,
Faculty
of
Medicine,
University
of
Western
Ontario,
London,
Ont.
N6A
5CL,
(519)
661-2074;
or
Faculty
of
Medicine,
Queen's
University,
Kingston,
Ont.
K7L
3N6,
(613)
545-2540
Apr.
15-22,
1989:
Family
Physician
Continuing
Medical
Education
in
Palliative
Care,
Pain
and
Midwifery
London,
England
Dianne
McCormack,
program
coordinator,
Continuing
Medical
Education,
Faculty
of
Medicine,
University
of
Western
Ontario,
London,
Ont.
N6A
5C1;
(519)
661-2074
May
2-6,
1989:
Obstetrics
and
Gynecology
Refresher
Course
King
Edward
Hotel,
Toronto
Continuing
Medical
Education,
Faculty
of
Medicine,
Medical
Sciences
Building,
University
of
Toronto,
Toronto,
Ont.
M5S
1A8;
(416)
978-2718
May
14-17,
1989:
31st
Annual
Scientific
Assembly
of
the
College
of
Family
Physicians
of
Canada
(conjoint
assembly
with
the
Saskatchewan
Chapter)
Bessborough
Hotel,
Saskatoon
Annual
Scientific
Assembly,
College
of
Family
Physicians
of
Canada,
4000
Leslie
St.,
Willowdale,
Ont.
M2K
2R9;
(416)
493-7513,
FAX
(416)
493-3224
May
14-18,
1989:
10th
International
Congress
of
Cytology
Sheraton
Hotel,
Buenos
Aires
Congress
Mailing
List,
International
Academy
of
Cytology,
5841
Maryland
Ave.,
HM
#449,
Chicago,
IL
60637,
USA;
(312)
702-6569,
FAX
(312)
955-8873
May
15-19,
1989:
International
Symposium
on
Medical
Informatics
and
Education
University
of
Victoria
Conference
Services,
University
of
Victoria,
PO
Box
1700,
Victoria,
BC
V8W
2Y2;
(604)
721-8475,
FAX
(604)
721-8653
June
4-9,
1989:
5th
International
Conference
on
AIDS
Convention
Centre,
Montreal
Deadline
for
abstracts
is
Jan.
31,
1989.
Kenness
Canada
Inc.,
P0
Box
120,
Stn.
B,
Montreal,
PQ
H3B
3J5;
(514)
844-4442,
FAX
(514)
284-2968
CMAJ,
VOL.
139,
JULY
1,
1988
49
