First intoxication with freshly picked Amanita phalloides in winter time in central Europe.

On December 5th of 2006 a 72 year old, otherwise healthy man from Asian descent, was admitted to the emergency department of a hospital in central Switzerland with symptoms of acute gastroenteritis. History revealed ingestion of a freshly picked mushroom 24 hours previously. Urine tested positive on α-amanitin. He was started on therapy with activated charcoal, N-acetylcysteine and silibinin. Due to imminent fulminant hepatic failure, he was transferred to a tertiary centre for assessment of emergency liver transplantation but fortunately, the liver function recovered after five days and he finally could be discharged home on day 7 in stable condition. To our knowledge, this is the first reported mushroom poisoning with Amanita phalloides in central Europe, caused by a freshly picked death cap in the month of December. Naturally death caps grow from May to October [1] in deciduous forests and parks. Accordingly, most cases of intoxication are noted in autumn, although occasionally poisoning with stored mushrooms has been reported in winter months [2]. Our case demonstrates that ‘off-season’intoxication with freshly picked death caps must be considered in patients with otherwise appropriate history of recent mushroom ingestion. It is possible that clima warming leads to more Amanita phalloides intoxication in atypical season.