HISTOLOGICAL CRITERIA FOR DIAGNOSIS OF AMANITA-PHALLOIDES POISONING

Five fatal cases of poisoning from ingestion of Amanita phalloides, a very common mushroom in central Italy, are reported. The fact that fou r of the cases occurred simultaneously enabled uniform collection of c linical, pathology and toxicology data, which is presented with partic ular emphasis on the histological aspects. The fifth case involved a s ix-year-old girl, and is discussed with reference to differential diag nosis with respect to Reye's syndrome, which was the initial diagnosis , demonstrated incorrect by the histology, pathology and toxicology fi ndings. The typical liver and kidney alterations of Amanita phalloides poisoning, consisting of massive hepatic central lobular cell necrosi s and acute tubular necrosis of the kidney are described. Outside the liver, there was often general hemorrhagic diathesis and severe brain edema. Although poisoning by Amanita phalloides is rare, these cases c onfirm the requirement for as complete a comparison as possible betwee n circumstantial histopathological and toxicological data for the purp oses of forensic diagnosis.