Delayed Amatoxin Poisoning Mimicking Gastroenteritis in a Rural Emergency Department: A Case Report

Abstract

ABSTRACT Introduction: Mushroom poisoning caused by amatoxin-containing species may initially present with mild gastrointestinal symptoms followed by a transient improvement, which can lead to delayed diagnosis. Case: A 54-year-old male living in a rural area presented to the emergency department with nausea and vomiting after consuming wild mushrooms he had foraged. On initial evaluation, his vital signs were stable and laboratory findings were within normal limits. Following symptomatic treatment, his complaints improved; however, despite being informed about all potential risks, the patient stated that he was experienced in mushroom foraging and chose to leave the hospital after signing a refusal of further examination and treatment. Two days later, he was readmitted with worsening symptoms, and laboratory tests revealed markedly elevated liver enzymes and coagulopathy. The clinical findings were consistent with amatoxin poisoning. Conclusion: Early clinical improvement in amatoxin poisoning may be misleading and can result in premature discharge. Therefore, careful evaluation and thorough patient counseling are essential in patients with a history of mushroom consumption.

Keywords

• mushroom poisoning
• delayed diagnosis; hepatotoxicity
• emergency department

Ethical Statement

Ethical approval was not required for this case report in accordance with institutional policies. Written informed consent was obtained from the patient for publication.

Kırsal Bir Acil Serviste Gastroenteriti Taklit Eden Gecikmiş Amatoksin Zehirlenmesi: Olgu Sunumu

Abstract

ÖZET Giriş: Amatoksin içeren mantar zehirlenmeleri başlangıçta hafif gastrointestinal semptomlarla seyredip geçici düzelme gösterebilir ve bu durum tanıda gecikmeye yol açabilir. Olgu: Kırsal bölgede yaşayan 54 yaşında erkek hasta, doğadan topladığı mantarları tükettikten sonra gelişen bulantı ve kusma ile acil servise başvurdu. İlk değerlendirmede vital bulguları stabil ve laboratuvar tetkikleri normaldi. Semptomatik tedavi sonrası şikayetleri gerileyen hasta, mantar toplama konusunda deneyimli olduğunu belirterek tüm risklerin anlatılmasına rağmen tetkik tedavi ret formu imzalayarak hastaneden ayrıldı. İki gün sonra şikayetlerinin artması üzerine tekrar başvuran hastada belirgin karaciğer enzim yüksekliği ve koagülopati saptandı. Klinik bulgular amatoksin zehirlenmesi ile uyumlu bulundu. Sonuç: Amatoksin zehirlenmelerinde erken dönemde görülen klinik düzelme yanıltıcı olabilir ve erken taburculuğa neden olabilir. Bu nedenle mantar tüketim öyküsü olan hastalarda dikkatli değerlendirme ve hasta bilgilendirmesi önemlidir.

Keywords

• mantar zehirlenmesi
• amatoksin
• gecikmiş tanı; hepatotoksisite

Ethical Statement

Bu olgu sunumu için, kurumsal politikalar doğrultusunda etik kurul onayı gerekmemektedir. Makalenin yayımlanması için hastadan yazılı aydınlatılmış onam alınmıştır. Çalışma, Helsinki Deklarasyonu ilkelerine uygun olarak gerçekleştirilmiştir.

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