ACMT Toxicology Visual Pearls – In “Spore” Taste
A 15-year-old male presents symptomatic several hours after inhaling spores of this mushroom as a home remedy for epistaxis. What is the presentation and pathophysiology of the toxic syndrome associated with this mushroom?
For a video of this mushroom in action: https://youtu.be/G_DXTlvvsco
- Dyspnea and cough from hypersensitivity alveolitis
- Flushing, nausea and vomiting from acetaldehyde accumulation
- Nausea, vomiting and hepatoxicity from RNA synthetase inhibition
- Seizures from reduced GABA production in the central nervous system
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
Clinical Presentation
- Following inhalation of spores, symptoms develop within hours to days
- Cough
- Dyspnea
- Rhinorrhea
- Nausea and vomiting
- Fever
- Myalgias/ arthralgias
Diagnostic Testing
- 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.
Treatment
- 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
Clinical Pearls
- 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.
References
- Rubensohn M. Inhalation pneumonitis in a dog from spores of puffball mushrooms. Can Vet J. 2009;50(1):93. PMID 19337622
- Burk WR. Puffball Usages Among North American Indians. J Ethnobiol. 1983;3(1):55-62.
- Strand RD, Neuhauser EB, Sornberger CF. Lycoperdonosis. N Engl J Med. 1967;277(2):89-91. PMID 6027138
- Diaz JH. A Puff of Spores. Wilderness Environ Med. 2018;29(1):119-122. PMID 28964695
- Goldfrank LR. Mushrooms. In: Nelson LS & Goldfrank LR et al eds: Goldfrank’s Toxicologic Emergencies 11th edition. 2019: New York: McGraw Hill Education.
- Centers for Disease C, Prevention. Respiratory illness associated with inhalation of mushroom spores–Wisconsin, 1994. MMWR Morb Mortal Wkly Rep. 1994;43(29):525-526.
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