{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:48:52Z","timestamp":1784033332996,"version":"3.55.0"},"reference-count":57,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>We encountered a case of mushroom intoxication complicated by \u201ctoxic-like\u201d myocarditis. Because of the lack of systematized knowledge on this subject, we performed a systematic review of the literature on cardiac toxicity in mushroom poisoning (MP). The aim of this study was to identify and describe the severity, the causal relationship, and the mushroom species involved in other reported cardiac events associated with MP. We included 39 studies in our review. We found 106 cases of cardiac events associated with MP, including 18 deaths. A wide variety of cardiac manifestations were reported, ranging from the simple elevation of cardiac enzymes (n = 61) to ventricular tachycardia (n = 14), acute heart failure (n = 18), and myocarditis (n = 7). Causal relationship between cardiac manifestations and mushroom poisoning was assessed for 42 patients, applying the algorithm validated by the French Toxicovigilance Coordination Committee. Twenty-three cases (54.8%) had a \u201cpossible\u201d causal relationship, eight cases (19%) a \u201cprobable\u201d relationship, and ten cases (23.8%) a \u201cvery probable\u201d relationship. Several fungal genera were involved in reported cases, including Amanita but also rarer ones like Russula and Tricholoma. In conclusion, we showed that cases of cardiac toxicity following MP have been documented in the existing literature, and for some of them, we assessed a strong causal relationship.<\/jats:p>","DOI":"10.3390\/toxins16060265","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T08:59:06Z","timestamp":1718009946000},"page":"265","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Mushroom Poisoning-Related Cardiac Toxicity: A Case Report and Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0152-9171","authenticated-orcid":false,"given":"Giuseppe","family":"Balice","sequence":"first","affiliation":[{"name":"Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7555-4995","authenticated-orcid":false,"given":"Maxime","family":"Boksebeld","sequence":"additional","affiliation":[{"name":"Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Barrier","sequence":"additional","affiliation":[{"name":"F\u00e9d\u00e9ration de Cardiologie M\u00e9dicale, H\u00f4pital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1829-5834","authenticated-orcid":false,"given":"Sara","family":"Boccalini","sequence":"additional","affiliation":[{"name":"Service de Radiologie Cardiovasculaire et Thoracique, H\u00f4pital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behrouz","family":"Kassai-Koupai","sequence":"additional","affiliation":[{"name":"Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France"},{"name":"Centre d\u2019Investigation Clinique de Lyon (CIC1407 INSERM), Hospices Civils de Lyon, 69500 Bron, France"},{"name":"Laboratoire de Biom\u00e9trie et Biologie Evolutive UMR 5558, Universit\u00e9 Lyon 1, CNRS, 69100 Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Paret","sequence":"additional","affiliation":[{"name":"Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5237-2581","authenticated-orcid":false,"given":"Guillaume","family":"Grenet","sequence":"additional","affiliation":[{"name":"Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, 69003 Lyon, France"},{"name":"Laboratoire de Biom\u00e9trie et Biologie Evolutive UMR 5558, Universit\u00e9 Lyon 1, CNRS, 69100 Villeurbanne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/01.CCM.0000153530.32162.B7","article-title":"Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings","volume":"33","author":"Diaz","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_2","first-page":"3195","article-title":"Mushroom poisoning--from diarrhea to liver transplantation","volume":"96","author":"Broussard","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1080\/00275514.2018.1479561","article-title":"Mushroom poisoning epidemiology in the United States","volume":"110","author":"Brandenburg","year":"2018","journal-title":"Mycologia"},{"key":"ref_4","unstructured":"Goldfrank, L.R., and Hoffman, R.S. (2006). Goldfrank\u2019s Toxicologic Emergencies, McGraw-Hill."},{"key":"ref_5","unstructured":"Rumack, B.H., and Spoerke, D.G. (1994). Handbook of Mushroom Poisoning: Diagnosis and Treatment, CRC Press."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2165\/00139709-200625030-00004","article-title":"New syndromes in mushroom poisoning","volume":"25","author":"Saviuc","year":"2006","journal-title":"Toxicol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.toxicon.2018.11.007","article-title":"Mushroom poisoning: A proposed new clinical classification","volume":"157","author":"White","year":"2019","journal-title":"Toxicon"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"616","DOI":"10.2459\/JCM.0000000000000837","article-title":"Acute myocarditis secondary to mushrooms ingestion as assessed by cardiac MRI: A case report and review of the literature","volume":"20","author":"Ponsiglione","year":"2019","journal-title":"J. Cardiovasc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.amjmed.2017.08.012","article-title":"Acute Myocarditis Due to Mushroom Ingestion","volume":"131","author":"Vallianou","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1056\/NEJMoa010581","article-title":"Wild-mushroom intoxication as a cause of rhabdomyolysis","volume":"345","author":"Bedry","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_11","first-page":"e65262","article-title":"Mushroom poisoning in children: A five-year review","volume":"29","author":"Deng","year":"2019","journal-title":"Iran. J. Pediatr."},{"key":"ref_12","first-page":"617","article-title":"Acute intoxication with Tricholoma equestre--clinical course","volume":"67","author":"Anand","year":"2010","journal-title":"Przegl. Lek."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.3346\/jkms.2016.31.7.1164","article-title":"A Case of Mushroom Poisoning with Russula subnigricans: Development of Rhabdomyolysis, Acute Kidney Injury, Cardiogenic Shock, and Death","volume":"31","author":"Cho","year":"2016","journal-title":"J. Korean Med. Sci."},{"key":"ref_14","first-page":"193","article-title":"A series of cases of rhabdomyolysis after ingestion of Tricholoma equestre","volume":"23","author":"Laubner","year":"2016","journal-title":"Acta Med. Litu."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"715","DOI":"10.3109\/15563659409017978","article-title":"Poisoning by amatoxin-containing mushrooms in suburban New York--report of four cases","volume":"32","author":"Feinfeld","year":"1994","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"iii1874","DOI":"10.1093\/ndt\/gfaa142.P1555","article-title":"Reversible aki and heart involvement resulting from amanita proxima poisoning treated with haemodialysis: A single-center case series","volume":"35","author":"Leonardi","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1111\/j.1445-5994.2012.02955.x","article-title":"A fatal case of \u2018magic mushroom\u2019 ingestion in a heart transplant recipient","volume":"42","author":"Lim","year":"2012","journal-title":"Int. Med. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"294","DOI":"10.5694\/j.1326-5377.2005.tb06705.x","article-title":"Fatal muscarinic syndrome after eating wild mushrooms","volume":"182","author":"Pauli","year":"2005","journal-title":"Med. J. Aust."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3109\/15563659809162584","article-title":"Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction","volume":"36","author":"Borowiak","year":"1998","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e245863","DOI":"10.1136\/bcr-2021-245863","article-title":"Psilocybin-induced takotsubo cardiomyopathy","volume":"15","author":"Kotts","year":"2022","journal-title":"BMJ Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1016\/j.ijcard.2007.12.064","article-title":"Apical regional wall motion abnormalities reminiscent to Tako-Tsubo cardiomyopathy following consumption of psychoactive fungi","volume":"134","author":"Nef","year":"2009","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.3109\/0886022X.2014.930649","article-title":"Temporary left ventricular dysfunction in mushroom poisoning: Report of three cases","volume":"36","author":"Altintepe","year":"2014","journal-title":"Ren. Fail."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jaccas.2022.07.033","article-title":"Successful Treatment of Near Fatal Cardiogenic Shock Following Toxic Mushroom Ingestion","volume":"4","author":"Kessler","year":"2022","journal-title":"JACC Case Rep."},{"key":"ref_24","first-page":"1248","article-title":"A refractory cardiac arrest induced by Amanita proxima poisoning successfully treated by percutaneous extracorporeal life support","volume":"80","author":"Machado","year":"2014","journal-title":"Minerva Anestesiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/nchembio.179","article-title":"Identification of the toxic trigger in mushroom poisoning","volume":"5","author":"Matsuura","year":"2009","journal-title":"Nat. Chem. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.fct.2007.10.014","article-title":"Indications of hepatic and cardiac toxicity caused by subchronic Tricholoma flavovirens consumption","volume":"46","author":"Nieminen","year":"2008","journal-title":"Food Chem. Toxicol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s11557-012-0809-y","article-title":"Trogia venenata (Agaricales), a novel poisonous species which has caused hundreds of deaths in southwestern China","volume":"11","author":"Zhu","year":"2012","journal-title":"Mycol. Prog."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1002\/anie.201106502","article-title":"Evidence for the natural toxins from the mushroom Trogia venenata as a cause of sudden unexpected death in Yunnan Province, China","volume":"51","author":"Zhou","year":"2012","journal-title":"Angew. Chem. Int. Ed. Engl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/BF03160979","article-title":"Amanita smithiana mushroom ingestion: A case of delayed renal failure and literature review","volume":"5","author":"West","year":"2009","journal-title":"J. Med. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1093\/ndt\/gfr511","article-title":"Amanita poisonings resulting in acute, reversible renal failure: New cases, new toxic Amanita mushrooms","volume":"27","author":"Kirchmair","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_31","first-page":"gin-32","article-title":"A rare case of acute renal failure related to amanita proxima ingestion","volume":"32","author":"Mancini","year":"2015","journal-title":"G. Ital. Nefrol."},{"key":"ref_32","first-page":"153","article-title":"Concentration of selected microelements in blood serum of rats exposed to the action of psilocin and phenylethylamine","volume":"53","author":"Majdanik","year":"2007","journal-title":"Ann. Acad. Med. Stetin."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3109\/15563659809028940","article-title":"Poisoning severity score. Grading of acute poisoning","volume":"36","author":"Persson","year":"1998","journal-title":"J. Toxicol. Clin. Toxicol."},{"key":"ref_34","unstructured":"Higgins, J.P.T., Li, T., and Deeks, J.J. (2022). Choosing effect. Cochrane Handbook for Systematic Reviews of Interventions Version 6.3, Cochrane."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_36","first-page":"93","article-title":"Anticholinergic toxicity after the ingestion of serotonergic \u2018magic mushrooms\u2019","volume":"16","author":"Aleman","year":"2012","journal-title":"Neth. J. Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.toxicon.2009.10.022","article-title":"A case report of an unusual complication of Amanita phalloides poisoning: Development of cardiogenic shock and its successful treatment with intra-aortic balloon counterpulsation","volume":"55","author":"Aygul","year":"2010","journal-title":"Toxicon"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.annfar.2012.01.021","article-title":"Occurrence of severe cardiac alterations in Amanita proxima poisoning: Two original observations","volume":"31","author":"Besancon","year":"2012","journal-title":"Ann. Fr. Anesth. Reanim."},{"key":"ref_39","first-page":"275","article-title":"Elevated cardiac enzymes due to mushroom poisoning","volume":"85","author":"Usul","year":"2014","journal-title":"Acta Biomed."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1136\/bmj.2.6103.1633","article-title":"Cardiac arrhythmia after mushroom ingestion","volume":"2","author":"Caley","year":"1977","journal-title":"Br. Med. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1111\/bcpt.12569","article-title":"Investigation of Toxic Effects of Mushroom Poisoning on the Cardiovascular System","volume":"119","author":"Erenler","year":"2016","journal-title":"Basic. Clin. Pharmacol. Toxicol."},{"key":"ref_42","first-page":"252","article-title":"Two cases of fulminant hepatic failure from amanita phalloides poisoning treated additively by homeopathy","volume":"14","author":"Frass","year":"2014","journal-title":"Ochsner J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s00059-014-4071-8","article-title":"Coronary vasospasm causing acute myocardial infarction: An unusual result of wild mushroom poisoning","volume":"40","author":"Kalcik","year":"2015","journal-title":"Herz"},{"key":"ref_44","first-page":"82","article-title":"Mushroom that break hearts: A case report","volume":"22","author":"Karakoc","year":"2018","journal-title":"Crit. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1111\/liv.13080","article-title":"Acute liver injury and acute liver failure from mushroom poisoning in North America","volume":"36","author":"Karvellas","year":"2016","journal-title":"Liver Int."},{"key":"ref_46","first-page":"20","article-title":"Two different intoxications with the same mushroom (Report Two Cases)","volume":"2","author":"Koyuncu","year":"2011","journal-title":"J. Emerg. Med. Case Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E17","DOI":"10.1053\/ajkd.2001.27725","article-title":"Rhabdomyolysis: An unusual feature with mushroom poisoning","volume":"38","author":"Lee","year":"2001","journal-title":"Am. J. Kidney Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.12998\/wjcc.v7.i16.2330","article-title":"Cardiac arrhythmias and cardiac arrest related to mushroom poisoning: A case report","volume":"7","author":"Li","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.toxicon.2021.04.011","article-title":"Extracorporeal membrane oxygenation combined with sequential blood purification in the treatment of myocardial damage and cardiac arrest caused by mushroom poisoning","volume":"197","author":"Li","year":"2021","journal-title":"Toxicon"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.wem.2015.03.027","article-title":"Russula subnigricans Poisoning: From Gastrointestinal Symptoms to Rhabdomyolysis","volume":"26","author":"Lin","year":"2015","journal-title":"Wilderness Environ. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.wem.2022.03.007","article-title":"Russula subnigricans Poisoning Causes Severe Rhabdomyolysis That Could be Misdiagnosed as Non-ST Segment Elevation Myocardial Infarction","volume":"33","author":"Min","year":"2022","journal-title":"Wilderness Environ. Med."},{"key":"ref_52","first-page":"477","article-title":"Unusual and severe cardiac effects in Amanita proxima poisoning: A case report","volume":"54","author":"Palma","year":"2016","journal-title":"Clin. Toxicol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e13011","DOI":"10.1111\/anec.13011","article-title":"Electrocardiogram of a patient with mushroom poisoning-induced myocarditis","volume":"28","author":"Qin","year":"2022","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"171","DOI":"10.5578\/tt.9411","article-title":"A patient with mushroom allergy; A new etiological agent of Kounis syndrome","volume":"64","author":"Tepetam","year":"2016","journal-title":"Tuberk. Toraks"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.2147\/IJGM.S271914","article-title":"Myotoxic mushroom poisoning in Thailand: Clinical characteristics and outcomes","volume":"13","author":"Trakulsrichai","year":"2020","journal-title":"Int. J. General. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1177\/0960327107083972","article-title":"Renal and hepatic injury with elevated cardiac enzymes in Amanita phalloides poisoning: A case report","volume":"26","author":"Unverir","year":"2007","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1016\/j.toxicon.2018.10.110","article-title":"Case series of a possible mushroom poisoning from Trogia venenata associated with gastroenteric symptoms, rhabdomyolysis, myocardial toxicity and sudden cardiac death in Yunnan, China, 2002\u20132012","volume":"158","author":"Zhao","year":"2019","journal-title":"Toxicon"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/6\/265\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:56:27Z","timestamp":1760108187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/16\/6\/265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":57,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["toxins16060265"],"URL":"https:\/\/doi.org\/10.3390\/toxins16060265","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]}}}