Elevated cardiac enzymes due to mushroom poisoning Sema Avcı, Eren Usul, Nezih Kavak, Fatih Büyükcam, Engin Deniz Arslan, Selim Genç, Seda Özkan Department of Emergency Medicine, Dı kapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey Summary. Mushroom poisoning is an important reason of plant toxicity. Wild mushrooms that gathered from pastures and forests can be dangerous for human health. Te clinical outcomes and symptoms of mushroom toxicity vary from mild gastrointestinal symptoms to acute multiple organ failure. Toxic efects to kidney and liver of amatoxin are common but cardiotoxic efects are unusual. In this case, we reported the cardiotoxic efect of amatoxin with the elevated troponin-I without any additional fnding in electrocardiography, echo- cardiography and angiography Key words: cardiac enzyme, mushroom, poisoning, toxicity, troponin Acta Biomed 2014; Vol. 85, N. 3: 275-276 © Mattioli 1885 Case report Case Report A 55-year-old-man admitted to emergency de- partment with dyspnea and palpitation seven hours after an unknown type of mushroom ingestion. Te patient stated that the mushrooms are gathered from Ilgaz Mountains National Park. Te patient told that visual hallucinations started two hours after ingestion. Te patient’s vital signs were as follows; blood pressure, 100/60 mmHg; body temperature, 36.7°C; hearth rate, 115 beats/min. On physical examination, the patient was oriented, alert and conscious. Tere was no chron- ic disease or medication in history. Laboratory results were as follows; alanine aminotransferase (ALT): 24U/L, aspartate aminotransferase (AST): 32U/L, troponin-I: 1.929 ng/mL (Siemens ADVIA Centaur® Troponin I Ultra), creatine kinase: 68 U/L, CK-MB: 26 U/L (Siemens ADVIA Centaur® CK-MB). Te electrocardiogram (ECG) revealed sinus tachycardia. Transthoracic echocardiography revealed no cardiac wall motion abnormality; cardiac functions were nor- mal; ejection fraction was 60% and systolic pulmo- nary arterial pressure was calculated as 30 mmHg. Tere was no pathology in thoracic radiography. Te patient hospitalized and followed in the coronary in- tensive care unit. Tere wasn’t any pathology in coro- nary angiography that was electively performed. On follow up; cardiac enzymes are decreased progressively. Troponin-I level was decreased to 0.613 ng/mL level at the 24 th hour of hospitalization. Patient was called for control after a week and there was no symptom or complication on examination. Discussion Te clinical outcomes and symptoms of mush- room poisoning vary from mild gastrointestinal prob- lems to acute multiple organ failure (1). Teir toxins are split into seven parts as amatoxins (cyclopeptides), orellanus (cortinarius species), gyromitrin (monome- tylhydrazine), muscarine, ibotenic acid, psilocybin and coprine (disulframlike) (1). Amanita group known as cytotoxic and harmful for kidney and liver; orellanine is harmful for kidneys (2). Amatoxin accelerates pro- tein synthesis and cell cycle; in this way that damages particularly hepatocytes, epithelial cells, mucosa in the intestinal lumen and renal tubular epithelium (3). Also it is estimated that Amanita group are responsible for death from mushroom toxicity (1).