amanita phalloides intoxication misdiagnosed as acute appendicitis: a case report

background: acute appendicitis is the most common surgical emergency of the childhood. its diagnosis is really challenging. a constellation of through history taking, physical examination, radiographic investigations, and laboratory analysis should be used to balance the risk of delayed operative intervention against the removal of a normal appendix. here a case with misdiagnosis of acute appendicitis instead of amanita phalloides intoxication was presented. case: a 6-years-girl was referred with history of constant, not-colicky lower quadrant and periumblical abdominal pain from 24 hours ago associated with nausea and vomiting. in physical examination generalized tenderness particularly in lower quadrants was found. leukocytosis (wbc=22000) with a shift to left (pmn=91%) and hypoglycemia was found too. alvarado score for diagnosis of acute appendicitis was 7 out of 10. in laparotomy, the appendix appeared normal. blood study revealed inr>7 during operation which was partially corrected with ffp infusion. the patient developed decreased levels of consciousness and was transferred to icu. further history taken from her family by the clinical toxicologist revealed that she had eaten wild mushrooms. after examination of the remaining mushrooms by an experienced biologist, the diagnosis of amanita phalloides intoxication was established. the patient died tomorrow regardless of appropriate interventions. conclusion: mushroom poisoning should be taken into account in evaluation of the patients suspected to have acute appendicitis. if diagnosis of mushroom poisoning was made earlier by proper history taking and a high index of suspicion, the patient would receive the available treatment modalities earlier and her chance of survival would increase.