Delayed treatment of misdiagnosed mushroom poisoning. Do organic anion transporting polypeptides’ substrates matter?

Abstract

A middle-aged man was admitted to the clinic four days after the ingestion of wild mushrooms. His medical history included type 2 diabetes, hypertension, and coronary bypass. Initially misdiagnosed with infectious enterocolitis, he was treated as an outpatient with IV fluids while continuing his chronic medications (statins, beta-blockers, aspirin). On day three, blood tests confirmed hepato-renal syndrome, and he was transferred to the clinic. On admission, he was alert with BP 100/60 mmHg, HR 100/min, sinus rhythm, right upper quadrant pain, and jaundice. Lab results showed thrombocytopenia, severe hepato-renal dysfunction, prolonged prothrombin time (29.3 sec), and a MELD score of 30. For three days, he was simultaneously exposed to amatoxin and chronic cardiovascular medications, both substrates for the same transporters. Treatment was adjusted to IV acetylcysteine (double regimen), oral silymarin (600 mg/day), and supportive therapy. He recovered within 10 days, with transaminases normalizing after three months. Understanding transporter-related drug interactions and patient-specific metabolic differences may improve future management strategies and patient survival. Further research is needed on alternative inhibitors of amatoxin uptake and competitive OATP substrates to expand treatment options.