Mushroom poisoning is a relatively rare cause of
acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of
mushroom poisoning. Liver damage from Amanita phalloides is related to the
amanitins, powerful toxins that inhibit
RNA polymerase II resulting in a deficient
protein synthesis and cell
necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement.
Amatoxin poisoning may progress into ALF and eventually death if
liver transplantation is not performed. The mortality rate after Amanita phalloides
poisoning ranges from 10 to 20%. The management of
amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification
therapies, and orthotopic
liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary
liver transplantation may represent additional therapeutic options.