Four Cases of Poisoning by Entoloma vernum

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2008-06, Vol.46 (5), p.408-408
• Main Authors: Saviuc, P, Moreau, P A, Fouilhe, S-LN, Gamelin, L, Pulce, C, Burlet, J M, Danel, V
• Format: Article
• Language: English
• Subjects: Entoloma
• ISSN: 1556-3650

Objective: Poisoning after ingestion of Entoloma vernum (=Rhodophyllus vernus, =Nolanea verna) has been mentioned in some books and described in only a few mycological publications to date (1-3). We report four cases of illness after ingestion of E. vernum on two different occasions. Case series: In 1999, a couple ate mushrooms mistaken for Marasmius oreades. Ten hours after the meal, the 58-year-old woman with a history of breast cancer presented with bilious vomiting, diarrhoea and some signs of dehydration (serum protein: 90 g/L). The 51-year-old man with no medical history presented 12 hours after the meal with nausea, uncontrollable vomiting and watery diarrhoea. They were both rehydrated with intravenous fluids and treated with antiemetic and antispasmodic agents. The mushroom leftovers were identified as E. vernum by a mycologist. In 2006, a mother and her daughter ate three spoonfuls each of mushrooms mistaken for Entoloma aprile. Ten hours after ingestion, the 66-year-old mother treated for arterial hypertension presented with nausea, frequent vomiting, diarrhoea and a nosebleed. Her daughter, a 48-year-old woman, presented 8.5 hours after the meal initially with severe vomiting, followed by headache, abdominal pain, diarrhoea and signs of dehydration (hematocrit: 0.53); total serum bilirubin level was 28.7 mu mol/L. They were both rehydrated with intravenous fluids for 24 hours. The next day, a mushroom species found at the place of mushroom gathering was identified as E. vernum by a mycologist. Conclusion: A severe gastrointestinal syndrome occurred in four patients within 8-12 hours of ingestion of E. vernum. These characteristics (severity, late onset) also are also typical of Entoloma lividum poisoning. Differential diagnosis with cyclopeptide poisonings can thus be problematic, especially in the initial phase of such a poisoning. A headache is sometimes present in the case of E. lividum poisoning; the hyperbilirubinaemia was not explained; the nosebleed may have been related to the physical stress of vomiting in a hypertensive woman.