ArticlePDF Available

Acute poisoning with Tricholoma equestre

Authors:

Abstract

Four cases, including three adults and one child, suffering from acute poisoning with Tricholoma equestre were described. The patients had eaten from 100 to 400 grams of the mushroom within a few consecutive meals. After consuming about 1000 grams of Tricholoma equestre for 3-4 days, the subjects developed fatigue, muscle weakness, myalgia, and in two cases acute respiratory failure with the need of respiratorotherapy. Maximal serum CK was 48136 U/L in the adults and 306 U/L in children. Maximal serum levels of AST and ALT were 802 U/L and 446 U/L in adults and 39 U/L, and 56 U/L in a child. All routine biochemical tests were within normal range. No other causes of rhabdomyolysis such as parasitic or viral infections, immune diseases, trauma or exposure to medications were found. Patient, aged 72 yrs., who developed acute respiratory failure, died in the second day of hospitalization. In other patients all the above mentioned symptoms and biochemical abnormalities disappeared from 2 to 3 weeks of hospitalization. Physicians should be aware of the possibility of appearance of rhabdo-myolysis after repeated consumption of large quantities of Tricholoma equestre.
339Przegl¹d Lekarski 2009 / 66 / 6
CLINICAL NOTES  DONIESIENIA KLINICZNE
Ostre zatrucie G¹sk¹ zielonk¹
Acute poisoning with Tricholoma equestre
1Pomerania Center of Toxicology, Gdañsk,
Poland
Head: Wojciech Waldman MD, PhD
2Unit of Internal Diseases, Regional Hospital
in Bia³a Podlaska, Poland
Head: Jolanta Siwek-Iwanicka MD
3Department of Anatomy
University of Physical Education in Bia³a
Podlaska, Poland
Head: Jan Rowiñski MD, PhD
4Mater Infirmorum Hospital Belfast
General and Hepatobiliary Surgery Ward
Additional key words:
acute intoxication
Tricholoma equestre
rhabdomyolysis
Dodatkowe s³owa kluczowe:
ostre zatrucie
G¹ska zielonka
rabdomioliza
Adres do korespondencji:
Sein Anand Jacek MD PhD
Pomerania Center of Clinical Toxicology
ul. Kartuska 4/6
80-104 Gdañsk, Poland
e-mail: jacek.anand@gmail.com
Jacek Sein ANAND1
Pawe³ CHWALUK2,3
Micha³ SUT4
Four cases, including three adults
and one child, suffering from acute
poisoning with Tricholoma equestre
were described. The patients had
eaten from 100 to 400 grams of the
mushroom within a few consecutive
meals. After consuming about 1000
grams of Tricholoma equestre for 3-4
days, the subjects developed fatigue,
muscle weakness, myalgia, and in two
cases acute respiratory failure with the
need of respiratorotherapy. Maximal
serum CK was 48136 U/L in the adults
and 306 U/L in children. Maximal se-
rum levels of AST and ALT were 802
U/L and 446 U/L in adults and 39 U/L,
and 56 U/L in a child. All routine bio-
chemical tests were within normal
range. No other causes of
rhabdomyolysis such as parasitic or
viral infections, immune diseases,
trauma or exposure to medications
were found. Patient, aged 72 yrs., who
developed acute respiratory failure,
died in the second day of hospitaliza-
tion. In other patients all the above
mentioned symptoms and biochemical
abnormalities disappeared from 2 to 3
weeks of hospitalization. Physicians
should be aware of the possibility of
appearance of rhabdo-myolysis after
repeated consumption of large quan-
tities of Tricholoma equestre.
W pracy przedstawiono cztery oso-
by, w tym trzy doros³e oraz dziecko, u
których dosz³o do znacznej rabdomio-
lizy w przebiegu zatrucia Tricholoma
equestre. Pacjenci spo¿ywali od 100
do 400 g grzyba przez kilka kolejnych
dni. Po spo¿yciu ok. 1000 g Tricholo-
ma equestre dosz³o u nich do pojawie-
nia siê os³abienia, bólów miêni, za
w dwóch przypadkach ostrej niewydol-
noci oddechowej, która wymaga³a
respiratoroterapii. Poziomy CPK u do-
ros³ych pacjentów siêga³y 48136 U/L,
za u dzieci 306 U/L. Najwy¿sze war-
toci ASPAT i ALAT wynosi³y odpo-
wiednio 802 U/L i 446 U/L u osób doro-
s³ych oraz 39 U/L i 56 U/L u dziecka.
Wszystkie rutynowe testy biochemicz-
ne nie wykazywa³y wiêkszych odchy-
leñ od normy. Nie znaleziono równie¿
¿adnych innych przyczyn rabdomioli-
zy, w tym m.in. chorób paso¿ytniczych,
wirusowych, immunologicznych, ura-
zów, a tak¿e niepo¿¹danego dzia³ania
leków. Pacjent lat 72, u którego dosz³o
do ostrej niewydolnoci oddechowej,
zmar³ w drugiej dobie leczenia. U po-
zosta³ych pacjentów wszystkie objawy
kliniczne oraz biochemiczne ust¹pi³y
po ok. 2-3 tygodniach leczenia. Leka-
rze powinni zawsze pamiêtaæ o mo¿li-
woci wyst¹pienia rabdomiolizy w
przebiegu wielokrotnego spo¿ycia du-
¿ej dawki Tricholoma equestre.
Introduction
We present four cases, including three
adults and one child, who were admitted to
the hospital from 2002 to 2008 because of
rhabdomyolysis caused by excessive con-
sumption of Tricholoma equestre.
Case report
Case number one and two: Mother and her son,
aged 48 and 20 years, respectively, were admitted to
the hospital because of the following symptoms: fatigue,
striated muscle weakness, myalgia especially in mus-
cles of the legs, loss of appetite, mild nausea, and pro-
fuse sweating. All symptoms appeared approximately 48
hours after the last meal containing Tricholoma eques-
tre, which had been eaten by the family recently (last
nine consecutive meals). The average dish contained
about 100-300 grams of this mushroom. No other symp-
toms like vomiting, diarrhoea, fever or erythema were
observed. Physical examination revealed regular heart
rate about 90 b./min in the mother and 85 b./min in the
son, blood pressures were 140/60 mmHg, and 125/70
mmHg respectively. No other important abnormalities
were found. Maximal serum CK activity was 18150 U/L
in the mother and 48136 U/L in the son. Maximal serum
levels of AST and ALT were 802 U/L and 446 U/L, in the
mother and 2002 U/L and 454 U/L, in the son. Other
hepatic, renal and coagulation tests, as well as electro-
lyte levels, including potassium values, were normal. All
symptoms disappeared within 3 weeks of supportive
treatment, however, the muscle weakness lasted for
about 2-3 months more.
Case number three: A five-year-old male child was
admitted to the clinic because of deep coma, cyanosis
and convulsions. All theses symptoms appeared about
4 hours after the last meal containing Tricholoma eques-
tre. Medical history revealed that the child had been eat-
ing about 300-400 grams of this mushroom daily for the
four consecutive days. Physical examination revealed
deep coma (4 score GCS), regular heart rate about 120/
min, blood pressure 110/60 mmHg, and breath rate about
6/min. There were: bilateral, positive Babiñski sign and
symmetrical increase muscle tone in the neurological
examination. No changes in computerized tomography
of the head, chest x-ray, lumbar puncture, encephalog-
raphy, echocardiography and toxicological tests were
found. The biochemical tests showed elevated serum
CK activity 306 U/L (normal range 5-130 U/L for a child),
340 Przegl¹d Lekarski 2009 / 66 / 6 S. Anand Jacek et al.
ALT 56 U/L (normal range 5-45 U/L for person between
1-19-year old), pH 7,28, BE 5,9 mEq/l, HCO3 22,9 mEq/
l, pO2 43,9 mmHg, pCO2 59,8 mmHg. Beacuse of acute
respiratory insufficiency the child was intubated and res-
piratorotherapy, lasted 34 hours, was applied. For the
next week after that extubation, the child still presented
with muscle weakness which included especially the pel-
vic girdle and the urinary bladder. The boy could not sit
or stand up without help, and the bladder had to be cath-
eterised to avoid urine retention. All the symptoms dis-
appeared within 2-3 weeks of hospitalisation.
Case number four: A man aged 72 was admitted to
the hospital because muscle weakness, and myalgia
(especially the quadriceps), which lasted for four days.
All symptoms appeared about 24 hours after the last
meal containing Tricholoma equestre. The patient had
eaten the mushroom for the last ten consecutive meals.
The average dish contained about 300-400 grams of
Tricholoma equestre. There were no changes in physi-
cal examination except muscle pain of both legs and
increasing problem with walking. Maximal CK activity
was 44767 U/L, CKMB 888 U/L, TNI 1,9 ng/ml, AST
1894 U/L, and ALT 490 U/L. Other hepatic, renal and
coagulation tests as well as electrolyte levels, including
potassium, were normal. No changes in computerized
tomography of the head, chest X-ray, echocardiography
and toxicological tests were found. In the second day of
hospitalisation the patient reported pain and weakness
of the muscle of the chest, shoulders and abdomen. The
patient complained of dyspnoea, and a few hours later
breathing problems appeared. The patient was trans-
ferred to the ICU, intubated and connected to the respi-
rator. About 4.5 hours later - cardiac arrest was noted
and CRP was ineffective.
Several studies for parasites and other microorgan-
isms (trichinella, toxoplasma, coxsackievirus, HIV, HCV
and HBV), as well as for systemic diseases were nega-
tive for all observed patients.
Discussion
The most common causes of rhabdo-
myolysis are muscle compression, neuro-
leptic malignant syndrome, intoxication with
alcohol, amphetamine, cocaine, antihyper-
lipidemic drugs, antihistamines, phenothia-
zines, theophylline or long-term use of le-
vodopa, quinidine, phenytoin, penicillamine
and others [2-5].
In 2001, Bedry and co-workers observed
rhabdomyolisis in twelve patients in south-
western France after excessive consump-
tion of Tricholoma equestre [1]. The main
symptoms described by the authors inclu-
ded muscle weakness, fatigue, myalgia
(especially in quadriceps), facial erythema,
nausea without vomiting, and diaphoresis
without fever. The same signs, except fa-
cial erythema, were observed also in our
cases.
The biochemical results showed marked
increase in CK, AST and ALT levels. Howe-
ver, in the child, the level of these enzymes
did not correspond well with the grave clini-
cal condition of the patient.
Quite interesting is a delay between Tri-
choloma equestre consumption and rhab-
domyolisis occurrence. Bedry and co-wor-
kers observed the clinical signs about 24-
72 hours after consuming the last three con-
secutive meals with this mushroom [1]. In
our cases the symptoms appeared after ha-
ving more than 1000 grams of Tricholoma
equestre in less than four days.
One of our patients died despite inten-
sive care because of acute respiratory fa-
ilure. The high mortality rate of about 25%
was also observed by Bedry and co-wor-
kers [1].
Conclusions
1. Physicians should be aware of the
possibility of acute intoxications after repe-
ated consumption of large quantities of Tri-
choloma equestre.
2. The clinical picture of poisonings with
this wild mushroom may be different in chil-
dren and adults.
3. There is a delay between ingestion
and onset of clinical symptoms.
4. Intoxication of Tricholoma equestre is
connected with high mortality rate (about
25%).
References
1. Bedry R., Baudrimont I., Deffieux G. et al.: Wild-
mushroom intoxication as a cause of rhabdomyolysis.
N Engl. J. Med. 2001, 345, 798.
2. Bourquia A., Jabrane A.J., Ramdani B., Zaid D.:
Toxicite' syste'mique de la paraphe'nyle'ne diamine:
quatre observations. Presse Med. 1988, 17, 1798.
3. Dromer C., Verdrenne C., Billey T. et al.:
Rhabdomyolyse a' la simvastatine: a' propos d'un
cas avec revue de la litte'rature. Rev. Rhum. Mal.
Osteoartic. 1992, 59, 281.
4. Laaksonen R., Jokelainen K., Laakso J. et al.: The
effect of simvastatin treatment on natural antioxidants
in low-density lipoproteins and high-energy phospha-
tes and ubiquinone in skeletal muscle. Am. J. Car-
diol. 1996, 77, 851.
5. Yagi H., el Hind A.M., Khalil S.I.: Acute poisoning
from hair dye. East. Afr. Med. J. 1991, 68, 404.
... 2,3,[5][6][7] Rhabdomyolysis is a syndrome of mushroom poisoning that is described as either rapid or delayed onset myotoxicity. 2,3 Mushroom poisoning with delayed onset myotoxicity reported in literature is associated with ingestion of selected Tricholoma species, including T. equestre, 2,[8][9][10][11][12] and possibly T. terreum. 2,13 However, some experts discuss and debate whether T. equestre is a toxic species. ...
... 20 Clinically, myotoxic mushroom-poisoned patients typically present with fatigue, myalgia, muscle weakness and dark urine representing rhabdomyolysis, with or without obvious gastrointestinal (GI) symptoms. [8][9][10][11][16][17][18] Some patients with severe illness develop acute renal failure, electrolyte disturbances (hyperkalaemia, hypocalcaemia), respiratory failure, acute myocarditis, cardiac arrhythmias, pulmonary oedema, cardiac failure or cardiovascular collapse. 8,11,[16][17][18] Fatalities have been reported from myotoxic mushroom poisoning. ...
... 8,11,[16][17][18] Fatalities have been reported from myotoxic mushroom poisoning. 8,[10][11][12]17 In some areas of Thailand, foraging for and consuming wild mushrooms are also popular, contributing to the incidence of mushroom poisoning in our country. 7 Besides amatoxin poisoning, myotoxic mushroom poisoning has significant or severe clinical effects. ...
Article
Full-text available
Purpose To describe the clinical characteristics and outcomes of myotoxic mushroom poisoning in Thailand. Patients and Methods We performed a retrospective cohort study of cases of myotoxic mushroom poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012–2016). Results Forty-one cases were included. Most (53.7%) were male with the average age of 49 years. In three cases, the mushrooms were identified as Russula species by an experienced mycologist. Common presenting symptoms were gastrointestinal (GI) symptoms and myalgia. The median onset of GI symptoms and symptoms suggesting rhabdomyolysis after consuming mushrooms was 2 hours (0.17–24 hours) and 24–48 hours (2–120 hours), respectively. Eight patients who ate the mushrooms together with other patients with rhabdomyolysis had GI symptoms but did not develop rhabdomyolysis. For patients with rhabdomyolysis, acute kidney injury (AKI) and hyperkalaemia occurred in 51.5% and 33.3% of cases, respectively. Median initial and maximum creatine phosphokinase (CPK) levels in patients with rhabdomyolysis were 31,145 and 47,861 U/L, respectively. Fifteen of 17 patients who were investigated for troponin levels had elevated troponin. Three patients had a low ejection fraction. Most patients (95.1%) were admitted to hospital, with a median stay of 5 days. The mortality rate was 26.8%. Treatments included intravenous fluid, urine alkalinization, haemodialysis and peritoneal dialysis. Among patients with rhabdomyolysis, AKI, hyperkalaemia during hospitalisation, maximum CPK level, maximum creatinine level and initial and maximum potassium levels were the factors found to be significantly different between patients who died and those who survived. Conclusion Myotoxic mushroom poisoning had a high mortality rate. Most patients had early or delayed onset of clinical symptoms after mushroom ingestion. Some patients developed severe cardiovascular effects. Early detection, close monitoring (especially serum potassium, creatinine, CPK and cardiac effect) and good supportive care were the main treatment modalities.
... 37 Seçilen Russula spp'nin alınması ile ilişkilidir (R. subnigrans). 38,39 Cyclopropylacetyl-(R)-carnitine, bu tür için benzersiz bir belirteç olarak tanımlanmıştır. 40 Geç Başlangıçlı Miyotoksisite: Etkili toksinler henüz tam olarak anlaşılmamış olsa da, son araştırmalar saponaceolid B ve M'nin bazı durumlarda birincil toksinler olabileceğini gösteriyor 41 , ancak deney hayvanlarında bu bulgunun insan patolojisine çevrilip çevrilmediği belli değildir. ...
... Seçilen Tricholoma alt gruplarının alımı ile ilişkilidir. Örneğin T. Equestre 38,39,40 , T. Terreum 41 , T. Auratum 41 gibi . ...
... It is only recently connected with the consumption of certain mushroom species. Tricholoma equestre, the yellow knight, which had a reputation of popular edible mushroom in western and northern Europe, was implicated in a series of rhabdomyolysis cases between 1992 and 2016 in France, Poland, Germany, and Lithuania, some of which had a fatal ending (Bedry et al., 2001;Anand et al., 2009;Laubner & Mikulevičienė, 2016;. Since then it has been debated if this mushroom is a cause of rhabdomyolysis, with contradicted evidence from different studies . ...
... In one of the reported cases, concentration of CPK following ingestion of Tricholoma equestre was 44767 U/L. Another report was a case of a patient who died due to respiratory failure caused by a strong intoxication with Tricholoma equestre despite an extensive treatment [24]. ...
Article
Full-text available
The problem of mushroom intoxication has been brought up more often in both scientific journals and media, particularly in autumn – the period when mushroom hunting is most intense. Mushroom intoxication is mainly perceived as being associated with acute hepatic insufficiency. However, apart from strong hepatotoxic effects, some mushroom species are characterized by effects that lead to renal damage, sometimes irreversible in character. This article relates to the toxic mushroom species considered to be nephrotoxic and discusses different mechanisms and symptoms of kidney injury as well as methods of treatment
... Tricholoma equestre ve Russula subnigricans miyotoksik mantarlardır ve rabdomiyolize neden olarak geç böbrek hasarı yapabilirler. Her iki mantar intoksikasyonunda da kardiyak kasların hasarına bağlı solunum yetmezliği, pulmoner ödem, miyokardit, kardiyovasküler kollaps gibi kardiyopulmoner komplikasyonlar ile ölümler bildirilmiştir(26). ...
Article
Full-text available
Mushroom poisoning is a frequently encountered health problem around the globe. Depending on its type and toxin, it results in a wide spectrum of issues that range from asymptomatic findings to fatal organ failure. Since the toxin of the mushroom leading to poisoning is often unidentified, syndromic classification may benefit clinical management according to the findings of target organ system toxicity. A 64-year-old female patient with comorbidities such as diabetes mellitus, coronary artery disease, hypertension and hyperlipidemia was admitted to the intensive care unit. Approximately four hours after consuming wild mushrooms the patient’s diarrhea, muscle cramps, cold sweating, blurry vision, coughing and shortness of breath complaints have been begun. Her respiratory system examination revealed tachypnea, generalized bilateral rhonchus, bronchorrhea and wheezing. Patient was normotensive and had bradycardia (heart rate 35 beats/minute). She had anxiety and the Glasgow Coma score was 15. Her pupillary bilateral isochoric, miotic and light reflexes were diminished. In her arterial blood gas pH level 7.26, partial carbon dioxide pressure: 34 mmHg, potassium: 5.3 mmol/L, sodium: 130 mmol/L, lactate: 5.3 mmol/L, bicarbonate: 16 mEq/L and base excess: -10,3 mmol/L was found. Target organ system toxicity findings and timing of occurrence indicated early-onset cholinergic syndrome. Treatments that consisted of intravenous atropine, fluid, electrolytes and sodium bicarbonate alleviated the toxicity in a short period of time. Late mycologic examination results that followed the treatment revealed that the patient was poisoned by Inocybe lacera, a mushroom type that contains muscarine. With this case presentation, we summarized the syndromic classification that we use in the clinical management in the light of current information in the literature.
... Mimo intensywnego leczenia chorzy ci zmarli [21]. W Polsce do tej pory odnotowano jeden przypadek śmiertelny zatrucia T. equestre [22]. ...
Article
Full-text available
Species of Tricholoma sect. Tricholoma are economically and ecologically important. Studies on the taxonomy of the section were mainly conducted in Europe and North America, but knowledge about this section’s species diversity in China remains rudimentary. In this study, phylogenetic analyses based on internal transcribed spacer (ITS) and morphological characteristics were used to investigate the species diversity of T. sect. Tricholoma in China. Our analyses indicate that nine species, T. citrinum, T. equestre, T. frondosae, T. mastoideum, T. olivaceoluteolum, T. portentosum, T. qiaomianjun, T. sinoportentosum, and T. virgatum, are distributed in China. Among these, T. citrinum, T. mastoideum, and T. qiaomianjun are newly described in this study. In addition, a key to the species of T. sect. Tricholoma in China is provided.
Article
Full-text available
Wild mushrooms are a vital source of income and nutrition for many poor communities and of value to recreational foragers. Literature relating to the edibility of mushroom species continues to expand, driven by an increasing demand for wild mushrooms, a wider interest in foraging, and the study of traditional foods. Although numerous case reports have been published on edible mushrooms, doubt and confusion persist regarding which species are safe and suitable to consume. Case reports often differ, and the evidence supporting the stated properties of mushrooms can be incomplete or ambiguous. The need for greater clarity on edible species is further underlined by increases in mushroom-related poisonings. We propose a system for categorizing mushroom species and assigning a final edibility status. Using this system, we reviewed 2,786 mushroom species from 99 countries, accessing 9,783 case reports, fromover 1,100 sources.We identified 2,189 edible species, of which 2,006 can be consumed safely, and a further 183 species which required some form of pretreatment prior to safe consumption or were associated with allergic reactions by some. We identified 471 species of uncertain edibility because of missing or incomplete evidence of consumption, and 76 unconfirmed species because of unresolved, differing opinions on edibility and toxicity. This is the most comprehensive list of edible mushrooms available to date, demonstrating the huge number of mushrooms species consumed. Our review highlights the need for further information on uncertain and clash species, and the need to present evidence in a clear, unambiguous, and consistent manner.
Article
Full-text available
Wild mushrooms are a vital source of income and nutrition for many poor com-munities and of value to recreational foragers. Literature relating to the edibilityof mushroom species continues to expand, driven by an increasing demand forwild mushrooms, a wider interest in foraging, and the study of traditional foods.Although numerous case reports have been published on edible mushrooms,doubt and confusion persist regarding which species are safe and suitable to con-sume. Case reports often differ, and the evidence supporting the stated proper-ties of mushrooms can be incomplete or ambiguous. The need for greater clarityon edible species is further underlined by increases in mushroom-related poi-sonings. We propose a system for categorizing mushroom species and assigninga final edibility status. Using this system, we reviewed 2,786 mushroom speciesfrom 99 countries, accessing 9,783 case reports, from over 1,100 sources. We iden-tified 2,189 edible species, of which 2,006 can be consumed safely, and a further183 species which required some form of pretreatment prior to safe consumptionor were associated with allergic reactions by some. We identified 471 species ofuncertain edibility because of missing or incomplete evidence of consumption,and 76 unconfirmed species because of unresolved, differing opinions on edibil-ity and toxicity. This is the most comprehensive list of edible mushrooms avail-able to date, demonstrating the huge number of mushrooms species consumed.Our review highlights the need for further information on uncertain and clashspecies, and the need to present evidence in a clear, unambiguous, and consistent manner.
Article
Full-text available
Wild mushrooms are a vital source of income and nutrition for many poor communities and of value to recreational foragers. Literature relating to the edibility of mushroom species continues to expand, driven by an increasing demand for wild mushrooms, a wider interest in foraging, and the study of traditional foods. Although numerous case reports have been published on edible mushrooms, doubt and confusion persist regarding which species are safe and suitable to consume. Case reports often differ, and the evidence supporting the stated properties of mushrooms can be incomplete or ambiguous. The need for greater clarity on edible species is further underlined by increases in mushroom‐related poisonings. We propose a system for categorizing mushroom species and assigning a final edibility status. Using this system, we reviewed 2,786 mushroom species from 99 countries, accessing 9,783 case reports, from over 1,100 sources. We identified 2,189 edible species, of which 2,006 can be consumed safely, and a further 183 species which required some form of pretreatment prior to safe consumption or were associated with allergic reactions by some. We identified 471 species of uncertain edibility because of missing or incomplete evidence of consumption, and 76 unconfirmed species because of unresolved, differing opinions on edibility and toxicity. This is the most comprehensive list of edible mushrooms available to date, demonstrating the huge number of mushrooms species consumed. Our review highlights the need for further information on uncertain and clash species, and the need to present evidence in a clear, unambiguous, and consistent manner.
Article
Full-text available
A series of 18 cases of acute hair dye (paraphenylenediamine) poisoning were reported. The characteristic features of swollen face and the chocolate brown colour of the urine were diagnostic. Asphyxia was found to be the major early challenge of life. Tracheostomy and intensive medical treatment with hydrocortisone and chlorpheniramine maleate (antihistaminic drug) and penicillin cover were life saving in all serious cases. The mild cases were successfully treated with hydrocortisone and chlorpheniramine maleate and penicillin without tracheostomy. The dye was detected in the urine by thin layer chromatography on silica gel and proved to be paraphenylenediamine. Early prompt diagnosis and clinical management proved to be life saving in both serious or mild hair dye poisoning.
Article
Full-text available
The growing popularity of eating wild mushrooms has led to an increase in the incidence of mushroom poisoning. Most fatalities are due to amatoxin-containing species, which cause fulminant hepatocytolysis, and to cortinarius species, which lead to acute renal damage. A 1996 report described a patient with hepatic failure, encephalopathy, and myopathy related to the ingestion of Amanita phalloides.1 Since 1992, 12 cases of delayed rhabdomyolysis have occurred in France after meals that included large quantities of the edible wild mushroom Tricholoma equestre.2 The circumstances of these 12 cases clearly implicate T. equestre as the cause. The mushroom was . . .
Article
It has been hypothesized that treating hypercholesterolemic patients with statins will lead not only to a reduction in cholesterol, but also to inhibited synthesis of other compounds which derive from the synthetic pathway of cholesterol. In theory, this could further lead to ubiquinone deficiency in muscle cell mitochondria, disturbing normal cellular respiration and causing adverse effects such as rhabdomyolysis. Furthermore, ubiquinone is one of the lipophilic antioxidants in low-density lipoprotein (LDL), and therefore it has also been hypothesized that statin treatment will reduce the antioxidant capacity of LDL. We investigated the effect of 6 months of simvastatin treatment (20 mg/day) on skeletal muscle concentrations of high-energy phosphates and ubiquinone by performing biopsies in 19 hypercholesterolemic patients. Parallel assays were performed in untreated control subjects. The muscle high-energy phosphate and ubiquinone concentrations assayed after simvastatin treatment were similar to those observed at baseline and did not differ from the values obtained in control subjects at the beginning and end of follow-up. These results do not support the hypothesis of diminished isoprenoid synthesis or energy generation in muscle cells during simvastatin treatment. Furthermore, the results of analysis of antioxidant concentrations in LDL before and after simvastatin treatment indicate that the antioxidant capacity of LDL is maintained in simvastatin-treated patients.
Toxicite' syste'mique de la paraphe'nyle'ne diamine: quatre observations
  • A Bourquia
  • A J Jabrane
  • B Ramdani
  • D Zaid
Bourquia A., Jabrane A.J., Ramdani B., Zaid D.: Toxicite' syste'mique de la paraphe'nyle'ne diamine: quatre observations. Presse Med. 1988, 17, 1798.
Rhabdomyolyse a' la simvastatine: a' propos d'un cas avec revue de la litte'rature
  • C Dromer
  • C Verdrenne
  • T Billey
Dromer C., Verdrenne C., Billey T. et al.: Rhabdomyolyse a' la simvastatine: a' propos d'un cas avec revue de la litte'rature. Rev. Rhum. Mal. Osteoartic. 1992, 59, 281.