Forty-two hours after ingesting an unknown mushroom, a 56-year-old man was admitted to a Turkish emergency department (1). Cardiac markers troponin I, creatine kinase (CK), CK-MB isoenzyme, and myoglobin were all elevated (1). The testing detected nothing less than myocardial infarction (2). This diagnosis, however, was not correct.
The clinicians noted in their report that despite the potentially confusing cardiac markers, the patient was diagnosed with hepatic and renal falure (1). This is because in cases of mushroom poisoning, “amatoxins” bind with “actin filaments within myocardiocytes or renal cells and/or its effects as circulating antitropin antibodies” causing the cardiac markers to become elevated (1).
The patient was treated with fluids, activated charcoal, antibiotics and silibinin (an active constituent of milk thistle) and improvement followed (1).
1. Unverir P, Soner BC, Dedeoglu E, Karcioglu O, Boztok K, Tuncok Y. Renal and hepatic injury with elevated cardiac enzymes in Amanita phalloides poisoning: a case report. Hum Exp Toxicol 2007;26:757-61.
2. Gaw A, Murphy MJ, Cowan RA, O’Reilly DStJ, Stewart MJ, Shepherd J. Clinical Biochemistry: An Illustrated Colour Text. Edinburgh: Churchill Livingstone Elsevier, 2008.