Klinische Wochenschrift

, Volume 64, Issue 19, pp 935–938 | Cite as

Severe hemolysis caused by antibodies against the mushroomPaxillus involutus and its therapy by plasma exchange

  • M. Winkelmann
  • W. Stangel
  • I. Schedel
  • B. Grabensee
Wissenschaftliche Kurzmitteilung

Summary

It has been shown that fatal “poisoning” with the mushroom speciesPaxillus involutus is caused by antibodies against the fungus in sensitized patients. Because circulating immune complexes play an important role, therapeutic procedures which can eliminate those complexes could stop immune hemolysis. A 37-year-old patient became severely ill after repeated ingestion of sufficiently cookedPaxillus involutus. As a result of hemolysis with reversible shock symptoms, acute renal failure developed. Plasma exchange with 3,000 ml albumin 5% was carried out daily during the first 3 days after admission. Each plasma exchange lowered free hemoglobin and immune complex levels by 60%–75%. Acute renal failure was successfully treated with hemodialysis.

Specific IgG-antibodies against membrane particles ofPaxillus involutus were detected by hemagglutination tests in the serum of the patient. The sequence of reactions resulting from the testing procedures strongly suggests the formation of immune complexes. These complexes are likely to bind to erythrocytes acting as innocent bystanders. Activation of the complement system finally results in hemolysis and shock. In addition to adequate shock treatment elimination of these immune complexes by plasma separation seems to be the therapy of choice.

Key words

Paxillus involutus Immune hemolysis Plasma exchange 

Abbreviations

BUN

Blood urea nitrogen

ECG

Electrocardiogram

HF

Heart frequency

HGG eq

Human γ-globulin equivalent

LDH

Lactate dehydrogenase

MCL

Midclavicular line

SGOT

Serum glutamate oxaloacetic transaminase

SGPT

Serum glutamate pyruvate transaminase

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Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • M. Winkelmann
    • 1
  • W. Stangel
    • 2
  • I. Schedel
    • 2
  • B. Grabensee
    • 1
  1. 1.Medizinische Klinik der Universität DüsseldorfGermany
  2. 2.Abteilung Blutbank — Immunhämatologie — TransfusionsmedizinMedizinische Hochschule HannoverGermany

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