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.

Patogênese das lesões associadas à intoxicação por Ramaria flavo-brunnescens em bovinos / Pathogenesis of lesions associated with poisoning by Ramaria flavo-brunnescens in cattle

O estudo da patogênese da intoxicação pelo cogumelo Ramaria flavo-brunnescens em bovinos foi realizado através da avaliação retrospectiva de tecidos selecionados de nove casos espontâneos e quatro casos experimentais. Para a investigação da patogênese das lesões observadas na língua, esôfago, casco e cauda, foram avaliadas as alterações histopatológicas e aspectos histoquímicos e histoquímico-ultra-estruturais das lesões. As técnicas histoquímicas utilizadas foram o Tricrômico de Masson e a oxidação seletiva da ceratina (OSC). O estudo histoquímico-ultra-estrutural foi realizado através da técnica de Swift sob microscopia eletrônica de transmissão. Os pelos da vassoura da cauda foram examinados sob microscopia de luz polarizada. Todas as alterações observadas nas estruturas ceratinizadas estudadas, mas especialmente nas que sofrem ceratinização dura, revelaram defeitos na ceratinização. Aliando ao estudo morfológico os resultados obtidos através da técnica da OSC e da microscopia eletrônica/técnica de Swift pode-se associar os defeitos na ceratinização a uma redução na quantidade de aminoácidos sulfurados (cistina), principalmente nas estruturas que sofrem ceratinização dura, sendo este provavelmente o principal mecanismo patogenético na intoxicação por R. flavo brunnescens em bovinos.

The pathogenesis of the lesions of Ramaria flavo-brunnescens poisoning in cattle was studied throughout the retrospective evaluation of selected tissues from nine spontaneous and four experimental cases of the disease. The pathogenesis of lesions observed in the tongue, esophagus, hoof, and tail was investigated analyzing microscopic lesions, histochemical and histochemical-ultrastructural changes. Histochemical techniques utilized were Masson's Trichrome and Selective Oxidation of Keratin (SOK). The histochemical-ultrastructural study was acomplished throughout the Swift method under transmission electron microscopy. Hair shafts of the tip of the tail were analyzed under polarized light. Lesions of varying degrees of severity were observed. All changes observed in the keratinized structures studied, mostly in the hard keratin, showed defective keratinization. The morphologic study and the results obtained with SOK and Swift techniques showed that the defective keratinization results of low amounts of sulphur containing amino acids (cystine) in hard keratin structures. This is probably the main pathogenetic mechanism of the lesions observed in R. flavo brunnescens poisoning in cattle.

Fatal mushroom poisoning caused by Amanita virosa in Thailand.

Consumption of toxic mushrooms belonging to the genus Amanita frequently leads to severe gastrointestinal distress followed by acute hepatic failure with a fatal outcome. In Thailand, valuable information as to the locally prevalent poisonous species, the preferred habitat and the management of suspected victims of intoxication is basically non-existent. We report here 5 cases of fatal poisoning with Amanita virosa having occurred in a family residing in the northeast of Thailand who as countless others had enjoyed mushroom gathering as a pasttime. Within 4 to 6 days after ingestion of the mushrooms, all had succumbed to acute hepatic failure with subsequent hepatoencephalopathy. Treatment modalities exist in the form of penicillin and silibinin, or thioctic acid administration followed by plasmapheresis. In cases taking a lethal course apparent from the results of liver biochemistry, liver transplantation is clearly indicated. In order to prevent mushroom poisoning altogether, educating the general population to that end certainly presents the method of choice.