Tender Nesting Polypore (Hapalopilus rutilans) poisoning: report of two cases

Introduction. Only four cases of Hapalopilus rutilans poisoning have been previously published. We report two new cases. Case reports. A father and his 13-year-old daughter picked mushrooms identified as Fistulina hepatica specimens and ate an unknown quantity (Hour 0). At Hour 12 post-ingestion, both subjects complained of abdominal pain, then nausea, vomiting, anorexia, asthenia, diplopia, and blurred vision. The father also had visual hallucinations. On Day 2 post-ingestion, clinical examination showed multidirectional nystagmus. The father also had balance disorders and both subjects emitted purple urine. Laboratory tests showed elevated serum creatinine and blood urea levels, proteinuria and leukocyturia in both subjects, and mild elevation of hepatic enzymes in the father. Urine color returned to normal on Day 2 and Day 7 post-ingestion in the girl and her father, respectively. Complete clinical and biochemical recovery was obtained within one week in both cases. Discussion. Signs and symptoms are similar to those previously reported after H. rutilans ingestion. This mushroom can be easily confused with F. hepatica. Purple discoloration of the urine after ingestion of a polyporic mushroom is highly suggestive of H. rutilans poisoning. Polyporic acid is probably the active toxin.