puffball mushroom spore

A 15-year-old male presents symptomatic several hours after inhaling spores of this mushroom as a home remedy for epistaxis. What is the presentation and pathophysiology of the toxic syndrome associated with this mushroom?

For a video of this mushroom in action: https://youtu.be/G_DXTlvvsco

  1. Dyspnea and cough from hypersensitivity alveolitis
  2. Flushing, nausea and vomiting from acetaldehyde accumulation
  3. Nausea, vomiting and hepatoxicity from RNA synthetase inhibition
  4. Seizures from reduced GABA production in the central nervous system

Answer: 1.  Dyspnea and cough from hypersensitivity alveolitis due to inhalation of spores from Lycoperdon or Calvatia spp, also known as puffball mushrooms.

What is Lycoperdonosis?

  • Lycoperdonosis is a syndrome resulting from massive exposure to spores of Lycoperdon spp or Calvatia spp mushrooms, more commonly known as puffballs.
  • Puffball mushrooms are widely distributed in North America and Europe, and form fruiting bodies in late summer through fall. Prior to decaying, puffballs are edible. 1,2
  • When these mushrooms dry out or decay they release large numbers of spores when compressed, shaken or eaten.
  • Inhalation of the spores induces a nasopharyngitis and GI symptoms as well as an inflammatory pneumonitis that develops within hours. 3,4
  • Myalgias, fatigue, fever and dyspnea develop over the course of days and can require several weeks to improve.
  • Individuals with underlying pulmonary disease such as asthma are at risk for respiratory failure and can require mechanical ventilation.3,5
  • The underlying pathophysiology is from pulmonary irritation/ resultant inflammation rather than fungal infection. 6
  • Purposeful inhalation of these spores have been used as a folk remedy for epistaxis and has resulted in pediatric cases of lycoperdonosis 1,2,4

Clinical Presentation

  • Following inhalation of spores, symptoms develop within hours to days
  • Cough
  • Dyspnea
  • Rhinorrhea
  • Nausea and vomiting
  • Fever
  • Myalgias/ arthralgias

Diagnostic Testing

  • Chest X-ray can show diffuse reticulonodular infiltrates
  • Spores can be detected in biopsied lung tissue for weeks after exposure along with diffuse inflammatory changes of the alveoli.
  • Fungal cultures are generally negative.

Treatment

  • Respiratory support as needed
  • Inhaled Bronchodilators
  • Antihistamines and antiemetics as needed
  • Systemic steroids and antifungals have been utilized but there are no controlled trials evaluating their efficacy 5,6

Clinical Pearls

  • Lycoperdonosis occurs from inhalation of spores of decayed puffball mushrooms
  • Initial symptoms are those of a hypersensitivity broncho-alveolitis
  • Patients may develop a systemic inflammatory response that can last several weeks

Treatment is supportive with oxygen, bronchodilators, antihistamines, and potentially systemic steroids and antifungals.

This post has been reviewed on behalf of ACMT by Brent Furbee, Bryan Judge, and Louise Kao.

References

  1. Rubensohn M. Inhalation pneumonitis in a dog from spores of puffball mushrooms. Can Vet J. 2009;50(1):93. PMID 19337622
  2. Burk WR. Puffball Usages Among North American Indians. J Ethnobiol. 1983;3(1):55-62.
  3. Strand RD, Neuhauser EB, Sornberger CF. Lycoperdonosis. N Engl J Med. 1967;277(2):89-91. PMID 6027138
  4. Diaz JH. A Puff of Spores. Wilderness Environ Med. 2018;29(1):119-122. PMID 28964695
  5. Goldfrank LR.  Mushrooms.  In: Nelson LS & Goldfrank LR et al eds:  Goldfrank’s Toxicologic Emergencies 11th edition. 2019: New York: McGraw Hill Education.
  6. Centers for Disease C, Prevention. Respiratory illness associated with inhalation of mushroom spores–Wisconsin, 1994. MMWR Morb Mortal Wkly Rep. 1994;43(29):525-526.
Bryan Ross, MD

Bryan Ross, MD

Medical Toxicology Fellow
Indiana University School of Medicine
Bryan Ross, MD

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Kristine Nañagas, MD

Kristine Nañagas, MD

Associate Professor of Clinical Emergency Medicine
Medical Toxicology Faculty
Indiana University School of Medicine
Kristine Nañagas, MD

@toxindiana

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