Answer: 1. Dyspnea and cough from hypersensitivity alveolitis due to inhalation of spores from Lycoperdon or Calvatia spp, also known as puffball mushrooms.
What is Lycoperdonosis?
- Lycoperdonosis is a syndrome resulting from massive exposure to spores of Lycoperdon spp or Calvatia spp mushrooms, more commonly known as puffballs.
- Puffball mushrooms are widely distributed in North America and Europe, and form fruiting bodies in late summer through fall. Prior to decaying, puffballs are edible. 1,2
- When these mushrooms dry out or decay they release large numbers of spores when compressed, shaken or eaten.
- Inhalation of the spores induces a nasopharyngitis and GI symptoms as well as an inflammatory pneumonitis that develops within hours. 3,4
- Myalgias, fatigue, fever and dyspnea develop over the course of days and can require several weeks to improve.
- Individuals with underlying pulmonary disease such as asthma are at risk for respiratory failure and can require mechanical ventilation.3,5
- The underlying pathophysiology is from pulmonary irritation/ resultant inflammation rather than fungal infection. 6
- Purposeful inhalation of these spores have been used as a folk remedy for epistaxis and has resulted in pediatric cases of lycoperdonosis 1,2,4
- Following inhalation of spores, symptoms develop within hours to days
- Nausea and vomiting
- Myalgias/ arthralgias
- Chest X-ray can show diffuse reticulonodular infiltrates
- Spores can be detected in biopsied lung tissue for weeks after exposure along with diffuse inflammatory changes of the alveoli.
- Fungal cultures are generally negative.
- Respiratory support as needed
- Inhaled Bronchodilators
- Antihistamines and antiemetics as needed
- Systemic steroids and antifungals have been utilized but there are no controlled trials evaluating their efficacy 5,6
- Lycoperdonosis occurs from inhalation of spores of decayed puffball mushrooms
- Initial symptoms are those of a hypersensitivity broncho-alveolitis
- Patients may develop a systemic inflammatory response that can last several weeks
Treatment is supportive with oxygen, bronchodilators, antihistamines, and potentially systemic steroids and antifungals.