Destroying angel

February 2, 2010, 12:27 am

One of the most eagerly awaited toxicology articles every year is the annual report from the American Association of Poison Control Centers National Poison Data System (NPDS). This report compiles data from all the cases on which poison centers around the U.S. were consulted.  In addition to raw data, the report briefly summarizes selected individual cases, which often are challenging or involve unusual toxins.  The 2008 compilation has just been published, and is available here. Over the next several days, we will review some of the more interesting cases from the report.

A 53-yo woman presented to the emergency department with nausea and vomiting 10-12  that began hours after consuming foraged wild mushrooms. Over the next three days, she developed increasing liver enzymes, coagulopathy, and metabolic acidosis, despite treatment with N-acetylcysteine.  Encephalopathy and cardiovascular collapse ensued, the the patient died on the fourth hospital day.  Autopsy revealed severe hepatic necrosis.  An expert identified the mushroom involved as Amanita bisporigera.

A. bisporigera, the “destroying angel”, is a white mushroom sometimes mistaken for non-toxic puffball or button varieties.  Unfortunately, like A. phalloides, it contains the deadly amatoxin.

Aside from support and liver transplantation as indicated, there is no known cure for amatoxin poisoning.  But Galen (AD 129-199), the famous Roman physician, wrote that he had discovered a cure:

“I have heard of a physician of Mysia who administered Fowl’s dung to persons suffering from fungus poisoning, and I myself have experimented with the remedy.  I have used finely powdered dung mixed with water or mixed with honey and vinegar.  The patients immediately on drinking the mixture vomited and recovered.  One must observe that the dung of a fowl at liberty is more efficacious than one in captivity.”  De simplicium medicamentorum tempermentis et facultatibus. (reference in Mushrooms: poisons and panaceas Benjamin DR.  W.H. Freeman, 1995)

You can’t beat those free-range chickens!


  1. precordialthump Says:

    Nice one Leon,

    Galen was such a jackass…

    Nasty stuff is amatoxin. Though part of me looks forward to the day I get to say “Nurse, get me silibinin, stat!”


  2. Rachel Says:

    Wow, amazing, eating dung will make you throw up. Very interesting blog, I’m glad to find it.

  3. Leon Says:

    Thanks Rachel. I’m glad you enjoy the blog!