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Acute liver failure caused by Amanita verna: a case series and review of the literature

Summary

This case study examines three patients who became severely ill after eating poisonous Amanita verna mushrooms in China. One patient successfully received a liver transplant and recovered, while the other two died from brain bleeding complications. The study highlights that liver transplantation can be life-saving for mushroom poisoning victims with severe liver failure, though doctors need better guidelines to decide when transplantation is the right choice.

Background

Amanita verna is one of the most toxic wild fungi in China with annual poisoning incidents and mortality rates as high as 50%. Mushroom poisoning has become the most serious foodborne disease in China, with 95% of incidents caused by Amanita species.

Objective

To analyze clinical data of three patients with Amanita verna poisoning treated simultaneously, with focus on the indications and timing of liver transplantation for acute liver failure caused by toxic mushroom poisoning.

Results

One patient (Case 1) successfully underwent liver transplantation and recovered with normalized liver function indices. Cases 2 and 3 died despite medical management, both developing intracerebral hemorrhage as a terminal complication. The study suggests MELD score greater than 30 and hepatic encephalopathy stage III-IV are indicators for liver transplantation.

Conclusion

Liver transplantation is an effective treatment for acute liver failure caused by Amanita poisoning and can improve survival rates. However, no internationally recognized guidelines exist for liver transplantation in mushroom poisoning-induced liver failure. Clinical judgment regarding transplantation timing is critical to avoid premature surgery or missing optimal intervention windows.
  • Published in:BMC Surgery,
  • Study Type:Case Series,
  • Source: PMID: 34953488, DOI: 10.1186/s12893-021-01434-6
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