Deadly mushrooms send 3 to UCSF hospital

Jim Doyle, Chronicle Staff Writer

Source of Article: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/06/BAJG1544MQ.DTL&tsp=1

Tuesday, January 6, 2009

Two 11-year-old boys from Albany and their 72-year-old grandmother, who was visiting the family from Ithaca, N.Y., became violently ill after eating the mushrooms, which they had harvested along a trail in Mount Tamalpais State Park. The twins were released from UCSF Medical Center on Monday, after spending eight days in the hospital, including four days in intensive care.

Their maternal grandmother, Sarah Elbert, who led the family's mushroom hunt, sustained liver damage but was released from the hospital over the weekend.

"They are all expected to make a full recovery," said Kate Schoen, a UCSF spokeswoman.

Mushroom poisonings are fairly rare, but experts say it is easy for those without training to mistake an edible species for a deadly one.

Even connoisseurs can be duped by the way a death cap presents itself. The toadstool with white spores is common in the Bay Area, but the color varies and can be affected by weather and odd growing conditions. Its telltale signs are often buried in soil.

Aficionados say the best place to acquire mushrooms for those without training is at the store.

Elbert, a former professor of environmental history, said she was surprised by the effects of the mushrooms she and her family consumed.

"I've been a mushroom hunter all my life," she said.

Her family went hiking on Dec. 28 on the Dipsea Trail near Mount Tamalpais. They picked two dozen mushrooms, and she made mushroom soup for dinner.

About 10 hours later, at 4 a.m., the three victims became violently ill with vomiting, abdominal pain and diarrhea. The boys' father, who ate a small portion of soup, had only diarrhea. His wife also had soup but did not become ill.

The twins were diagnosed with inflammation of the pancreas and liver damage. The hospital prepared for the possibility that the boys would need liver transplants.

Doctors initially had difficulty identifying the specific culprit. The boys' mother returned to the site where the mushrooms were picked. An expert with the Mycological Society of San Francisco - which offers mushroom walks and workshops - helped identify the culprit as Amanita phalloides.

"Ithaca does not have aminitas," Elbert said. "They were scattered under the live oaks with many, many other kinds of mushrooms."

Dr. Kent Olson, the medical director of the San Francisco division of the California Poison Control System, said the death cap is "extremely potent in very small quantities."

He said the state had one death by mushroom poisoning in 2008.

Doctors used an arsenal of several different medications to attack the poison, including penicillin and acetylcysteine - but there is no known antidote for this toxin.

Doctors also obtained a waiver from the U.S. Food and Drug Administration for an organic compound, milk thistle derived silimarin, which was air-freighted to the hospital from Germany.

"It's hard to know within the first 24 to 48 hours who is going to make a recovery or who is going to need a transplant - and who may progress to death," said Dr. Sue Rhee, a pediatric gastroenterologist at UCSF Children's Hospital.

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