AMANITA-PHALLOIDES INTOXICATIONS IN A FAMILY OF RUSSIAN IMMIGRANTS - CASE-REPORTS AND REVIEW OF THE LITERATURE WITH A FOCUS ON ORTHOTOPIC LIVER-TRANSPLANTATION

Alpha-amanitin, the main toxin of the death cap fungus (Amanita phallo ides) is one of the most dangerous natural poison. This toxin damages eukaryotic cells by inhibiting their transcription. Lesions are seen i n cells with rapid protein synthesis, particular in liver and renal ce lls, even at low toxin concentrations. Without adequate intensive ther apy, the outcome of alpha-amanitin poisoning is very poor. This articl e reports various courses of amanitin intoxication in a family. In 3/4 patients, severe hepatic failure developed as assessed by a decrease of all coagulation factors, mainly Quick's test and factor V (< 10%-15 %). Despite vigorous replacement of coagulation factors, in 1 of the p atients orthotopic liver transplantation had to be performed on day 4, whereas in all other patients liver function improved spontaneously. All patients survived their intoxication. Both the pharmacological bas is and clinical manifestations of Amanita intoxication are discussed. On this basis a treatment scheme is presented which the authors believ e may be useful to clinicians.