AB211. SOH21AS252. Multifocal osteonecrosis following ingestion of the “Death Cap” mushroom: a rare occurrence
Orthopaedic Poster Session

AB211. SOH21AS252. Multifocal osteonecrosis following ingestion of the “Death Cap” mushroom: a rare occurrence

Peggy Emily Miller, Paula McQuail, Kevin McSorley, Paul Curtin

Department of Trauma and Orthopaedics, St. Vincent’s University Hospital, Dublin, Ireland

Background: Amanita Phalloides or “death cap” is one of the most dangerous variants of fungi found in Western Europe and North America. While hepatic and renal necrosis are widely reported following ingestion of this toxin, multifocal osteonecrosis is yet to be described. We present the simultaneous polyarticular functional decline and challenging management of our patient following such an occurrence. Additionally, we illustrate the rare occurrence of atraumatic patellar osteonecrosis as a component of her presentation.

Methods: We present the case of a 44-year-old female who presented to our institution with fulminant hepatic failure and subsequent multi-organ failure following ingestion of Amanita Phalloides mushrooms. Following liver transplant and diffuse dermal necrosis requiring multiple skin grafts, she became bed-bound due to intractable lower limb pain. Plain film and MRI investigations revealed bilateral Ficat stage 4 avascular necrosis of both hips with associated florid myositis. The overlying skin on her left hip had ongoing serous ooze from the split thickness skin graft sites, exacerbated limited mobility. She underwent synchronous bilateral Corail Pinnacle (Warsaw, IN, USA) total hip replacements. Further radiological investigation revealed right patellar osteonecrosis.

Results: Her left hip wound and overlying skin developed superficial soft tissue infection post-operatively. This was managed with intravenous antibiotics and resolved after 6 weeks. Her right knee pain contributed to a difficult post-operative rehabilitation.

Conclusions: Amanita Phalloides ingestion is often fatal. We document a rare presentation of a simultaneous polyarticular atraumatic osteonecrosis of the hips and unilateral patella in the setting of ‘death cap’ toxin ingestion and subsequent liver transplant.

Keywords: Amanita Phalloides; avascular necrosis; osteonecrosis of the patella; multifocal osteonecrosis; avascular necrosis toxin ingestion

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-21-ab211
Cite this abstract as: Miller PE, McQuail P, McSorley K, Curtin P. SOH21AS252. Multifocal osteonecrosis following ingestion of the “Death Cap” mushroom: a rare occurrence. Mesentery Peritoneum 2021;5:AB211.

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