Neurotoxicity associated with the medicinal mushroom product-Diamond Shruumz: A case report

A 17-year-old girl who ate a chocolate bar marketed as a medicinal mushroom product developed altered mental status, dilated pupils, salivation, and muscle jerks that did not respond to benzodiazepines. She required a breathing tube but all symptoms resolved within 8 hours, and she was discharged the next day. The product, "Diamond Shruumz," had been recalled because it likely contained muscimol, the main toxin in Amanita muscaria mushrooms. This case shows that unregulated medicinal mushroom supplements can be contaminated with toxic substances, producing a recognizable toxidrome. It is among the first reports of such contamination in a commercially available product.

Study at a glance

Abstract

Medicinal mushrooms are widely available as health supplements, and the federal government does not currently require these products to be examined for quality and contents. This places consumers at risk for unintentional ingestion of other substances, including toxic mushroom species. We describe a case report of an ingestion of an edible medicinal mushroom product likely contaminated with muscimol, the primary toxin of Amanita muscaria. A 17-year-old female presented with altered mental status, mydriasis, salivation, and myoclonic jerks that were refractory to benzodiazepines. She was intubated for airway protection and had spontaneous improvement of all her symptoms with return to baseline within 8 hours of presentation. She disclosed ingestion of the chocolate bar brand “Diamond Shruumz” that has been recalled for muscimol contamination. She was discharged home the day after presentation without symptom recurrence. This case displays the toxidrome of muscimol ingestion consistent with prior reports in the literature from muscimol containing mushroom ingestion. To our knowledge, this is among the first reports of Amanita muscaria ingestion from a commercially available medicinal mushroom product.