Clitocybe

Background

Clitocybe rivulosa

• Genus of mushroom, many species of which contain muscarine, a toxin that induces cholinergic symptoms, with some species (e.g. Clitocybe dealbata and Clitocybe rivulosa, the "fool's funnel" or "false champignon") known to cause potentially fatal poisonings

Clinical Features

• Symptoms usually start within 0.5-2hrs and resolve within 12hrs
• SLUDGE(M) syndrome (hyperperistalsis)
  • Salivation, Lacrimation, Urination, Diarrhea, GI pain, Emesis, Miosis
• Bradycardia
• Miosis
• Bronchorrhea / Bronchospasm
• Sweating
• Vasodilation

Differential Diagnosis

Mushroom toxicity by Type

Mushroom	Toxin	Pathologic Effect
Amanita	Amatoxin	Hepatotoxicity
	Coprine	Disulfiram-like
Crotinarius	Orellanine	Delayed renal failure
Gyromitra	Gyromitrin	Seizures
	Ibotenic Acid	Anticholinergic
	Muscarine	Cholinergic
	Orellanin	Nephrotoxicity
	Psilocybin	Hallucinations

SLUDGE Syndrome

• Carbamate toxicity
• Mushroom toxicity, especially:
  • Amanita muscaria
  • Inocybe
  • Clitocybe
• Organophosphate toxicity
• Nerve agent
  • Sarin
  • VX
  • Novichok agent
• Nicotine toxicity (look alike)
• Acetylcholinesterase inhibitor overdose (e.g in myasthenia gravis or post anesthesia reversal)

Evaluation

• Clinical diagnosis
• Evaluation to assess for alternative diagnoses

Management

• Atropine for muscarinic symptoms
• Supportive care, including careful airway monitoring/management

See Also

• Mushroom toxicity
• Cholinergic crisis