Garcia, JulianaCosta, Vera M.Costa, Ana ElisaAndrade, SérgioCarneiro, Ana CristinaConceição, FilipePaiva, José ArturPinho, P. Guedes deBaptista, PaulaBastos, Maria de LourdesCarvalho, Félix2018-02-192018-03-012018-03-052018-01-192018-03-012018-03-052015Garcia, Juliana; Costa, Vera M.; Costa, Ana Elisa; Andrade, Sérgio; Carneiro, Ana Cristina; Conceição, Filipe; Paiva, José Artur; De Pinho, Paula Guedes; Baptista, Paula; De Lourdes Bastos, Maria; Carvalho, Félix (2015). Co-ingestion of amatoxins and isoxazoles-containing mushrooms and successful treatment: A case report. Toxicon. ISSN 0041-0101. 103, p. 55-590041-0101http://hdl.handle.net/10198/16113Mushroom poisonings occur when ingestion of wild mushrooms containing toxins takes place, placing the consumers at life-threatening risk. In the present case report, an unusual multiple poisoning with isoxazoles- and amatoxins-containing mushrooms in a context of altered mental state and poorly controlled hypertension is presented. A 68-year-old female was presented to São João hospital (Portugal) with complaints of extreme dizziness, hallucinations, vertigo and imbalance, 3 h after consuming a stew of wild mushrooms. The first observations revealed altered mental state and elevated blood pressure. The examination of cooked mushroom fragments allowed a preliminary identification of Amanita pantherina. Gas chromatography-mass spectrometry (GC-MS) showed the presence of muscimol in urine. Moreover, through high-performance liquid chromatography-ultraviolet detection (HPLC-UV) analysis of the gastric juice, the presence of α-amanitin was found, showing that amatoxins-containing mushrooms were also included in the stew. After 4 days of supportive treatment, activated charcoal, silybin and N-acetylcysteine, the patient recovered being discharged 10 days post-ingestion with no organ complications. The prompt and appropriate therapy protocol for life-threatening amatoxins toxicity probably saved the patient's life as oral absorption was decreased and also supportive care was immediately started.engAmanita pantherinaAmanita phalloidesAmatoxinsIntoxicationIsoxazolesWild mushroomsjournal article10.1016/j.toxicon.2015.06.012