Main features of Cortinarius spp. poisoning:: a literature review

Introduction: Cortinarius spp. poisoning is characterized by a delayed acute renal failure. The main features of this severe poisoning are still poorly known and often overlooked. The aim of this literature review is a better description of Cortinarius spp. poisoning. Materials and Methods: The main medical databases were searched: Abstracts of Mycology, Current Contents, Medline, Pascal, Micromedex Poisindex, Toxicology abstracts, Toxline. All case reports that included a description of the clinical features of Cortinarius spp. poisoning were studied. Results: 245 cases were collected and 90 cases could be analyzed in details. Gastrointestinal disorders are the main symptoms of the prerenal phase of the poisoning. They appear a few days after the ingestion of the mushrooms (median 3 days). The renal phase is delayed (median 8.5 days). Moderate and transient hepatic abnormalities have been reported. A severe hepatic failure can be ruled out. Muscular lesions are highly questionable. Treatment is supportive. No specific treatment can be recommended. Acute renal failure progressed towards chronic renal failure in half of the cases; intermittent hemodialysis or kidney transplantations were necessary in 70% of those cases. Conclusion: Cortinarius spp. poisoning is severe. Ingestion of Cortinarius species must be systematically suspected whenever tubulo-interstitial nephritis is diagnosed, especially as mushrooms may have been ingested 1-2 weeks before. (C) 2001 Elsevier Science Ltd. All rights reserved.