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

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.

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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

References

  1. Bschorr F, Kohlmeyer J, Mallach HJ (1963) Neue Vergiftungsfälle durchPaxillus involutus. Pilzkunde 29:1–11

    Google Scholar 

  2. Bschorr F, Mallach HJ (1963) Vergiftungen durch den Kahlen Krempling, eine genießbare Pilzart. Arch Toxicol 20:82–95

    Google Scholar 

  3. Deicher H, Stangel W (1977) Akute immunhämolytische Anämie nach genuß des Kahlen Kremplings. Verh Dtsch Ges Inn Med 83:1606–09

    Google Scholar 

  4. Krause W, Matheis H, Wulf K (1969) Experimentelle Fungiämie und Fungiurie durch orale Verabreichung großer Mengen von Candida albicans beim gesunden Menschen. Arzneimittelforsch 19:85–91

    Google Scholar 

  5. Schmidt J, Hartmann W, Würstlin A, Deicher H (1971) Akutes Nierenversagen durch immunhämolytische Anämie nach Genuß des Kahlen Kremplings (Paxillus involutus). Dtsch Med Wochenschr 96:1188–91

    Google Scholar 

  6. Volkheimer G, et al. (1968) Primary portal transport of persorbed starch granules from the intestinal wall. Med Exper 18:103–08

    Google Scholar 

  7. Volanakis J, Stroud RM (1972) Rabbit Clq: purification, functional and structural studies. J Immunol Methods 2:25–34

    Google Scholar 

  8. Walker WA, Wu M, Isselbacher KJ, Bloch KJ (1975) Intestinal uptake of macromolecules, III. Studies of the mechanism by which immunization interferes with antigen uptake. J Immunol 115:854–861

    Google Scholar 

  9. Warshaw AL, Bellini CA, Walker WA (1977) The intestinal mucosal barrier to intact antigenic protein. Am J Surg 133:55–58

    Google Scholar 

  10. Winkelmann M, Borchard F, Stangel W, Grabensee B (1982) Tödlich verlaufene immunhämolytische Anämie nach Genuß des Kahlen Kremplings (Paxillus involutus). Dtsch Med Wochenschr 31/32:1190

    Google Scholar 

  11. Zubler RH, Lange G, Lambert PH, Miescher PA (1976) Detection of immune complexes in unheated sera by a modified125J-Clq binding test. J Immunol 116:232–235

    Google Scholar 

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Winkelmann, M., Stangel, W., Schedel, I. et al. Severe hemolysis caused by antibodies against the mushroomPaxillus involutus and its therapy by plasma exchange. Klin Wochenschr 64, 935–938 (1986). https://doi.org/10.1007/BF01728620

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  • DOI: https://doi.org/10.1007/BF01728620

Key words

  • Paxillus involutus
  • Immune hemolysis
  • Plasma exchange