Tuberc Respir Dis.  2013 Dec;75(6):264-268.

An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae

• Jang J
• Kim CH
• Yoo JJ
• Kim MK
• Lee JE
• Lim AL
• Choi JH
• Hyun IG
• Shim JW
• Shin HS
• Han J
• Seok SJ

Abstract

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

Keyword

Korea; Mushroom Poisoning

MeSH Terms

Agaricales*
Aged*
Anoxia
Anti-Bacterial Agents
Azotemia
Colony-Stimulating Factors
Diagnosis
Diarrhea
Eating*
Fibroblasts
Granulocytes
Hospitalization
Humans
Hyalin
Hypotension
Korea
Lung
Membranes
Mouth
Mushroom Poisoning
Nausea
Necrosis
Pancytopenia
Pneumonectomy
Pneumonia
Poisoning
Radiography
Renal Replacement Therapy
Respiration, Artificial
Respiratory Insufficiency*
Sensation
Thorax
Vomiting
Anti-Bacterial Agents
Colony-Stimulating Factors

Figure

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  Figure 1 (A) Chest radiography at admission shows slight costophrenic angle blunting. (B) The consolidations are rapidly more aggravated in two-thirds of the left lung on hospital day 4.

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  Figure 2 Chest computed tomography on hospital day 4 shows extensive consolidation in the left lung, multiple consolidations in the sublobular to subsegmental areas in the right lung, and a small amount of pleural effusion in both lungs.

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  Figure 3 Variable lung histology associated with Podostroma cornu-damae poisoning. Extensive hemorrhagic necrosis (A; H&E stain, ×40), massive inflammatory cell infiltration causing interstitial pneumonitis (B; H&E stain, ×200), type II pneumocyte hyperplasia, prominent proliferation of young fibroblasts, and sprouting alveolar lining cells (C; H&E stain, ×400); in addition, fibrin exudates and hyaline membrane formation (D; H&E stain, ×400) were seen.

• 

  Figure 4 A poisonous Podostroma cornu-damae. The remaining clusters of the mushroom consumed by the patient (A), and a photograph of it as found in the Korean mountains (B).

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