Three cases of wood-lover paralysis: clinical insights from Victoria, Australia.

Introduction: Wood-lover paralysis is a rare complication of Psilocybe mushroom ingestion. The clinical spectrum is poorly characterized and published cases remain limited. Case presentations: We describe three patients who developed acute muscle weakness following ingestion of Psilocybe mushrooms in Victoria, Australia. Written informed consent was obtained from these patients for publication of this case series. • case 1: Mild generalized weakness affecting gait, without other end-organ involvement. • case 2: Severe generalized weakness involving upper and lower limbs, associated with takotsubo cardiomyopathy. • case 3: Severe generalized weakness with respiratory failure, requiring intubation.All patients had a clear temporal relationship between mushroom ingestion and symptom onset. Mushroom samples from Cases 2 and Case 3 were identified as Psilocybe subaeruginosa based on DNA sequence data. Serum toxicology detected psilocin in Case 1 and Case 3.

Discussion: Our findings support a causal role for Psilocybe subaeruginosa; however, no specific alkaloid has yet been proven to cause wood-lover paralysis.

Conclusion: These cases highlight the variable severity of wood-lover paralysis, ranging from mild weakness to life-threatening respiratory compromise, and add significantly to the current body of literature on this topic.