Epileptik Bir Çocukta Amanita Virosa Alımı Sonrası Refrakter Status Epileptikus Oluşması

Öz

Giriş: Status epileptikus nöbetinin benzodiyazepin uygulanmasından sonra bir geleneksel entiepileptik ilaç infüzyonuna rağmen devam etmesi ise refrakter status epileptikus olarak tanımlanmaktadır. Mantar zehirlenmeleri değişik klinik tablolara neden olabilmektedir. Mantar zehirlenmelerine bağlı epileptik nöbet geliştiği bilinmekle birlikte literatürde amanita virosa grubu mantar zehirlenmesine bağlı status epileptikus geliştiğine dair bir bilgi bulunmamaktadır. Olgu Sunumu: Altı yaşında, son iki yıldır nöbet öyküsü olmayan ve ilaçlarını düzenli kullanan epileptik erkek hasta, mantar alımı sonrası refrakter status epileptikus tablosunda acil servise getirildi. Antiepileptik tedavi ile kontrol altına alınamayan nöbet aktivitesi genel anestezi eşliğinde entübasyon ve mekanik ventilasyon uygulaması ile kontrol altına alındı. Laboratuar incelemeleri, PTZ ve aPTT yüksekliği dışında normaldi. Takibinde ek problem olmayan ve stabil hale gelen hasta yatışının beşinci günde şifa ile taburcu edildi. Sonuç: Hastada mantar zehirlenmesinin konvülziyon eşiğini düşürücü etkisinin olabileceği düşünüldü. Bu olgu ile zehirlenmelerde kliniğin her zaman klasik literatür bilgilerine uymayabileceği, bazen de farklı kliniklerin bir hastada aynı anda görülebileceğinin düşünülmesi gerektiği vurgulandı.

Anahtar Kelimeler

• Amanita virosa, çocuk, mantar zehirlenmesi, refrakter, status epileptikus

Refractory Status Epilepticus After Ingestion of Amanita Virosa in an Epileptic Child

Öz

Introduction: Status epilepticus is considered refractory when seizure activity continues after receiving treatment with a benzodiazepine followed by infusion of traditional antiepileptic drugs. Mushroom poisoning may lead to variable clinical pictures. Although it is known that mushroom poisoning may develop epileptic seizures, there are no data about status epilepticus associated with amanita virosa mushroom poisoning in the literature. Case Report: A 6-year-old epileptic patient who regularly used antiepileptic drugs and had no seizures for 2 years was admitted to the emergency department due to refractory status epilepticus after ingestion of mushroom. Seizures that were refractory to antiepileptic therapy was controlled with intubation and mechanical ventilation after general anesthesia. Laboratory tests were normal, except elevated PTZ and aPTT. The patient, who had no additional problems and stabilized, was discharged on the fifth day of admission. Conclusion: We suggested that mushroom poisoning may reduce the threshold for seizures in our patient. In this study, it is emphasized that different clinical features may be found in a patient at the same time

Anahtar Kelimeler

• Amanita virosa, child, mushroom poisoning, refractory, status epilepticus

Kaynakça

1. Brophy GB, Bell R, Alldredge A, Bleck TP, Claassen J, LaRoche SM, et al. Neurocritical Care Society Status Epilepticus Guideline Neurocrit Care Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17: 3-23. [CrossRef]
2. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 2002; 59: 205-10. [CrossRef]
3. Kohn R, Mot’ovska Z. Mushroom poisoning: classification, symptoms and therapy. Vnitrni lekarstvi 1997; 43: 230-33.
4. Riviello JJ Jr, Claassen J, LaRoche SM, Sperling MR, Allredge B, Bleck TP et al. Treatment of status epilepticus: an international survey of experts. Neurocrit Care 2013; 18: 193-200. [CrossRef]
5. Piering WF, Bratanow N. Role of the clinical laboratory in guiding treatment of Amanita virosa mushroom poisoning: report of two cases. Clinical Chemistry 1990;36: 571-74.
6. Enjalbert F, Rapior S, Nouguier-Soulé J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-Year retrospective analysis. J Toxicol Clin Toxicol 2002; 40: 715-57. [CrossRef]
7. Leist M, Gantner F, Naumann H, Bluethmann H, Vogt K, Brigelius-Flohe R, et al. Tumor necrosis factor-induced apoptosis during the poisoning of mice with hepatotoxins. Gastroenterology 1997; 112: 923-34. [CrossRef]
8. Wittebole X, Hantson P. Use of the molecular adsorbent recirculating system (MARS) for the management of acute poisoning with or without liver failure. Clinical Toxicology 2011; 49: 782-93. [CrossRef]

9. Sorodoc L, Lionte C, Sorodoc V, Petris O, Jaba I. Is MARS system enough for A. phalloides-induced liver failure treatment? Human and Experimental Toxicology 2010; 29: 823-32. [CrossRef]
10. Schmidt LE, Dalhoff K. Risk factors in the development of adverse reactions to N-acetylcysteine in patients with paracetamol poisoning. British Journal of Clinical Pharmacology 2001; 51: 87-91. [CrossRef]