Foraging Mistakes Lead to Cluster of Mushroom Poisoning Cases
One by one, the sickened patients arrive at Einstein Medical Center Philadelphia with nausea, vomiting, elevated liver levels, lethargy. There are four in one day, another one the next day.
One of the patients dies of liver failure. Another one needs a liver transplant.
It isn’t drugs or flu or COVID. What is it?
“There’s not very many things that can cause such high elevation in liver enzymes,” says Julie Sullivan, DO, who is called in on Sept. 27 when the first patient arrives. Dr. Sullivan is a first-year fellow in Gastroenterology/Hepatology (digestive and liver diseases).
But Einstein’s toxicology department is already on the case, having been alerted by the regional Poison Control Center. And the culprit turns out to be – poisonous mushrooms.
All the patients who arrive with liver failure and severe liver damage from the same condition in just a couple of days have eaten wild mushrooms they foraged and ate in soups or salads.
Mushroom foraging is a practice that’s become popular in the United States with the surge in natural farm-to-table eating and the increased opportunity to be outdoors during the pandemic. This past year’s dry summer and rainy autumn also created the perfect conditions for abundant mushroom growth.
13 Cases in the State, 6 at Einstein
While wild mushroom poisoning is not unheard of, the severity of the illness in these cases prompted the Pennsylvania Department of Health to issue an alert in November. The outbreak of serious illness affected 13 people in the state, according to the health department, six of them treated at Einstein.
“Einstein is a long-standing and very successful liver transplant hospital, with outcomes that are among the best in the state in terms of survival,” says Victor Navarro, MD, Chair of Medicine at the Einstein Healthcare Network, now part of Jefferson Health.
“We also have aggressive outreach activities to connect with referring doctors and hospitals, making our group easy to reach in an emergency.”
One otherwise healthy patient who was spiraling towards death required a liver transplant and survived. One Einstein patient died of liver failure, though he was older and had contributing health issues. The others were treated, some in the ICU, and were released.
Treatment includes rapid recognition of the poison mushroom and use of a specific antidote that blocks the passage of the toxin into the liver. If delayed, treatment is ineffective.
The coordination among the toxicology department, the referring hospitals and the Einstein hepatology team allowed patients who were candidates for antidotes to receive them in time.
And two first-year fellows in GI/Hepatology experienced a rare cluster of cases that their more experienced colleagues have never witnessed.
“We’ve been told by more experienced attending physicians that this is really unique, that they’ve only seen one or two cases during their entire practice,” says Shikha Talwar, MD.
“I never thought I’d see this kind of case in my training,” says Dr. Sullivan.
It’s One for the Medical Journals
Drs. Sullivan and Talwar are documenting the phenomenon and plan to submit their paper to a professional journal for publication. Two fellows in toxicology – Christopher Mitchell, MD, and Elizabeth Shanahan, MD – who consulted with the regional Poison Control Center to solve the mystery are also working on the research.
“We want to get this out in the community and into the hepatological and toxicology literature, to warn providers at this time of the year to look out for foragers when they’re taking a history,” Dr. Sullivan says.
Two of the Einstein patients were sickened from mushrooms picked in an open field in the Fox Chase section of the city. Another picked mushrooms in a neighbor’s backyard while he was mowing the lawn. And another picked them from a neighborhood park.
All of them went foraging for food, except one patient who was seeking a hallucinogenic experience, which some mushrooms produce.
Dr. Mitchell notes that at least four of Einstein’s patients were born in Europe and Asia, where mushroom foraging is common. “A common thing that happens is that mushrooms here look similar to edible mushrooms they’ve picked in their home countries. But the ones here are dangerous.”
The growing popularity of mushroom foraging in the United States is reflected on social media, where one TikTok site on the topic has 2 million followers.
The growing exposure on social media has misled people into overestimating their ability to discern edible mushrooms from poisonous ones, according to Robert Bassett, DO, head of the regional Poison Control Center.
“The safest way to make sure your mushrooms are nontoxic is to buy them in a retail store.”