Akutes Leberversagen nach Knollenblätterpilz-Ingestion

Zusammenfassung

Amatoxine, welche hauptsächlich in Amanita phalloides, Amanita virosa, and Galerina autumnalis gefunden werden, sind für die Mehrheit der fatalen Pilzintoxikationen verantwortlich. Die Intoxikation ist mit einem akuten Leberversagen vergesellschaftet, welches die schlechte Prognose begründet. Der akuten Leberschädigung geht meist eine gastrointestinale Phase mit Übelkeit, Erbrechen und Durchfall voraus. Im weiteren Verlauf können sich ein prärenales Nierenversagen (u.a. aufgrund des einhergehenden Flüssigkeitsdefizits) sowie ein fulminantes Leberversagen entwickeln. Einheitliche Richtlinien zur Therapie bei Amanita-Inintoxikation gibt es nicht. Wir berichten wir über drei Patienten, die nach Verzehr einer selbst-gesammelten Pilzmahlzeit an einer Amanita-Intoxikation erkrankt sind. Basierend auf der Pathophysiologie der Knollenblätterpilzvergiftung diskutieren wir ein mögliches therapeutisches Vorgehen.

Abstract

Amatoxins, which are mainly found in Amanita phalloides, Amanita virosa, and Galerina autumnalis, are responsible for the majority of fatal intoxication with green death cap. The intoxication is associated with acute liver failure, which explains the poor prognosis. Acute liver injury is generally preceeded by a gastrointestinal phase with nausea, vomiting and diarrhea. In the course, pre-renal kidney failure due to the associated fluid deficit and fulminant liver failure may occur. General guidelines for the treatment of amatoxin poisoning are yet not available. We report on three patients who suffered from amatoxin mushroom poisoning after ingestion of green death cap mushrooms. Based on the pathophysiology of amatoxin poisoning, we discuss a potential therapeutic approach.

Schlüsselwörter

Knollenbläterpilzvergiftung - Amanita phalloides - Amatoxin - akutes Leberversagen

Keywords

death cap intoxication - Amanita phalloides - amatoxin - acute liver failure

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