Eritema flagelado por ingesta de hongos Shiitake: reporte de caso / Flagellated erythema due to Shiitake mushroom intake: report of case

El eritema flagelado es una erupción cutánea poco frecuente con múltiples causas, dentro de las cuales se encuentra la ingesta de hongos shiitake crudos o semicrudos. Se postula que es secundario a una reacción de hipersensibilidad Th-1 producida por el lentinan, un polisacárido termolábil de la pared celular del hongo. En años recientes ha aumentado su incidencia en el mundo occidental debido a la creciente popularidad de la comida asiática, en la que los hongos shiitake son un ingrediente muy utilizado. El cuadro clínico se caracteriza por la aparición de lesiones eritematosas lineales pruriginosas principalmente en tronco y extremidades, de curso autolimitado. El diagnóstico es principalmente clínico, basado en el antecedente de ingesta reciente de hongos shiitake y el rash característico y el tratamiento es sintomático con antihistamínicos y corticoides tópicos u orales. A continuación, presentamos un caso de eritema flagelado en una mujer joven, secundario a ingesta de hongos shiitake, que se resolvió completamente en 2 semanas.

Flagellate erythema is a rare skin eruption with many causes, including the ingestion of raw or undercooked shiitake mushrooms. It is thought to be a Th-1 hypersensitivity reaction produced by lentinan, a thermolabile polysaccharide found in the cell wall of the mushroom. In recent years, there has been an increase in the number of cases due to the growing popularity of Asian cuisine, in which shiitake mushrooms are a central ingredient. The clinical presentation is characterized by the appearance of linear, erythematous, pruritic lesions mostly on the trunk and extremities, of self-limited course. Diagnosis is mainly clinical, based on the history of recent shiitake mushroom ingestion and the characteristic rash, and treatment is symptomatic, with antihistamines and topical or systemic steroids. In this report, we present a case of flagellate erythema in a young woman, that appeared after the ingestion of shiitake mushrooms, and resolved completely after 2 weeks.

Intoxicación con Amanita phalloides: serie de tres casos / Amanita phalloides poisoning: series of three cases

Se presenta una serie de tres casos de pacientes adultos con intoxicación por Amanita phalloides, ocurridos entre los años 2010 y 2011. Dos pacientes eran de sexo masculino, de 40 y 75 años de edad, y la mujer de 65 años. En todos los casos se asoció el cuadro clínico a la práctica de recolección casera de hongos para preparación de alimentos (actividad sostenida durante más de 10 años en todos los casos). La recolección se realizó en zonas de robles en un caso, y en zonas de castaños en los otros dos casos. En los tres casos la consulta se realizó entre las 16 y 36 h de la ingesta. Los tres pacientes desarrollaron diarrea, hepatopatía y falla hepática sin encefalopatía. A todos se les realizó tratamiento con carbón activado seriado, aspirado duodenal y penicilina endovenosa. El trasplante hepático fue necesario en uno de los casos. No hubo secuelas hepáticas en ninguno de los pacientes. Conclusiones: la práctica de recolección de hongos silvestres para consumo humano es un hábito riesgoso si se realiza por personas inexpertas en el reconocimiento de las especies tóxicas. Si bien la intoxicación por A. phalloides es un cuadro poco frecuente, su alta morbimortalidad hace indispensable el reconocimiento temprano y abordaje oportuno por parte de los médicos.

We present a series of three cases of Amanita phalloides poisoning in adult patients admitted during the period 2010 - 2011. Two patients were males of 40 and 75 years old, and the third was a woman of 65 years old. In all cases, the poisoning was associated with the home practice of collecting wild mushroom for cooking (activity traditionally carried out for more than 10 years in all cases). Mushroom collection was carried out in areas of oak trees for one case, and in areas of chestnuts trees in the two other cases. In all three cases the admission took place between 16 and 36 hours from intake. All three patients developed diarrhea, liver disease and liver failure without encephalopathy. All patients received treatment with activated charcoal (serial administration), duodenal aspiration and intravenous penicillin. Liver transplantation was necessary in one case. There were no hepatic sequelae in any patients. Conclusions: The practice of collecting wild mushrooms for human consumption is a risky habit if performed by people untrained in recognition of toxic species. While poisoning with A. phalloides is uncommon, its high mortality makes indispensable its early recognition and treatment by physicians.

Hepatoprotective herbal drug, silymarin from experimental pharmacology to clinical medicine.

Silymarin, a flavonolignan from 'milk thistle' (Silybum marianum) plant is used almost exclusively for hepatoprotection and amounts to 180 million US dollars business in Germany alone. In this review we discuss about its safety, efficacy and future uses in liver diseases. The use of silymarin may replace the polyherbal formulations and will avoid the major problems of standardization, quality control and contamination with heavy metals or bacterial toxins. Silymarin consists of four flavonolignan isomers namely--silybin, isosilybin, silydianin and silychristin. Among them, silybin being the most active and commonly used. Silymarin is orally absorbed and is excreted mainly through bile as sulphates and conjugates. Silymarin offers good protection in various toxic models of experimental liver diseases in laboratory animals. It acts by antioxidative, anti-lipid peroxidative, antifibrotic, anti-inflammatory, membrane stabilizing, immunomodulatory and liver regenerating mechanisms. Silymarin has clinical applications in alcoholic liver diseases, liver cirrhosis, Amanita mushroom poisoning, viral hepatitis, toxic and drug induced liver diseases and in diabetic patients. Though silymarin does not have antiviral properties against hepatitis virus, it promotes protein synthesis, helps in regenerating liver tissue, controls inflammation, enhances glucuronidation and protects against glutathione depletion. Silymarin may prove to be a useful drug for hepatoprotection in hepatobiliary diseases and in hepatotoxicity due to drugs. The non traditional use of silymarin may make a breakthrough as a new approach to protect other organs in addition to liver. As it is having a good safety profile, better patient tolerability and an effective drug at an affordable price, in near future new derivatives or new combinations of this drug may prove to be useful.