Blood purification therapy for acute hepatic failure caused by Amanita virosa

Abstract

Consumption of Amanita virosa is a medical emergency requiring hospitalization. No definitive antidote for it is available. A man in his 50s with fulminant hepatitis was transferred to our hospital. He had hepatic encephalopathy grade 3, highly raised liver enzymes and hemoconcentration. It was suspected that the liver dysfunction was due to mushroom poisoning, since he had consumed Amanita virosa 2 days previously. In order to absorb Amanita toxin, which is highly toxic, repeated doses of activated carbon were applied, while treating the dehydration resulting from fluid loss. In addition, acute blood purification therapy that included plasma exchange (PEX) and high-flow-high-volume hemodiafiltration (hf-hv HDF) was performed for the toxin and high polymer removal with liver failure treatment. Two days after starting the PEX, % prothrombin improved. The hepatic encephalopathy improved five days after trarting the hf-hv HDF. The liver atrophy was slight as determined by computed tomography, and liver enzymes were normalized. He left the hospital 9 days after hospitalization. Blood purification therapy in cases of Amanita virosa poisoning is still controversial. However, the present study showed that it was effective against fulminant hepatitis due to Amanita virosa poisoning. The reason why it was effective was that the blood purification therapy was started within 48 hours of poisoning onset. This outcome suggested that immediate blood purification therapy is more likely to be effective when Amanita virosa poisoning is suspected.