Severe Neurologic Toxicity in a Case of Repeated Muscimol Isolate Overdose

Abstract

Background Amanita muscaria is a mushroom known for its psychologically active compounds, specifically muscimol and ibotenic acid. A recent growing interest in advertised psychotropic effects and health benefits of Amanita muscaria has led to an increase in ingestion of Amanita muscaria containing compounds, which may lead to increased frequency of emergency department visits. Case Report We present a case of 38-year-old male who purchased a reportedly 99.4% pure muscimol-containing isolate from an online vendor. He presented on two separate occasions post-ingestion to the emergency department with altered mental status and myoclonus, requiring intubation on both encounters. Why should an emergency physician be aware of this? A review of case reports involving exposures to Amanita muscaria and muscimol-containing compounds shows patients often develop myoclonus and altered mental status, but also a multitude of other symptoms. The broad manifestations of exposure may be explained by unlabeled or non-purified extract resulting from a lack of federal oversight regarding vitamin and supplement manufacturing. To the best of our knowledge, the ingestion of 99.4% muscimol isolate described here represents the first allegedly pure muscimol-specific toxidrome in humans available in the literature. Our patient exhibited significant alteration in mentation that resulted in intubation on both presentations. Intubation is not a benign intervention so knowledge regarding this toxidrome is critical to manage patients appropriately and reduce risk.