POISONING BY AMATOXIN-CONTAINING MUSHROOMS IN SUBURBAN NEW-YORK - REPORT OF 4 CASES

We report four cases of poisoning with amatoxin-producing mushrooms in suburban Long Island. All occurred when amateur mushroom hunters pick ed mushrooms from neighboring lawns. Two patients presented 30 hours p ost ingestion with evidence of acute hepatic dysfunction. One survived , after treatment with charcoal and penicillin; the other, a 90-year-o ld woman with prior cardiac disease soon developed shock and subsequen tly died. The other two patients were admitted 18 hours after ingestio n of Lepiota chlorophyllum and received prompt charcoal hemoperfusion. Both did well, although one had a mild elevation of transaminases. Al though most reports of amatoxin poisoning originate in Europe, these c ases confirm that amatoxin-producing mushrooms, including Lepiota chlo rophyllum, may be found in northeastern American suburbs. Such patient s who present prior to 24 hours after ingestion should receive charcoa l hemoperfusion if a lethal dose (> 50 g of mushroom) has been eaten.