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-Case Reports-
A Case of Reversible Encephalopathy Accompanied by Demyelination Occurring after Ingestion of Sugihiratake Mushrooms
1Department of Neurology, Kitamurayama Public Hospital, Yamagata
2Department of Neurology, Yamagata Prefectural Kahoku Hospital
3Department of Neurological and Nephrological Science, Graduate School of Medicine, Nippon Medical School
4Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (DNHMED), Yamagata University School of Medicine
Recently, an outbreak of acute encephalopathy associated with Sugihiratake mushroom ingestion has been reported in northern Japan. Patients with chronic kidney diseases are thought to be at risk for severe encephalopathy following Sugihiratake mushroom ingestion. We report a case of encephalopathy associated with Sugihiratake mushroom ingestion in a patient with diabetic nephropathy. Brain magnetic resonance imaging showed discriminative intensity in the medial temporal lobe, claustrum, and insula cortex bilaterally. Cerebrospinal fluid examination revealed mildly elevated protein and marked elevation of myelin basic protein without pleocytosis. Twenty-five days after admission, these signal-intensity changes had markedly improved, and the patient was discharged without sequelae. Although the exact mechanism of this acute encephalopathy remains undetermined, demyelination is believed to be a possible associated pathological change. In cases of encephalopathy of undetermined cause with distinct magnetic resonance findings, Sugihiratake mushroom intoxication should be considered in areas where ingestion of this mushroom is common.
J Nippon Med Sch 2007; 74: 261-264
Keywords
mushroom intoxication, encephalopathy, myelin basic protein, magnetic resonance
Correspondence to
Tatsuya Nomoto, Department of Neurology, Kitamurayama Public Hospital, 2-15-1 Onsen-machi, Higashine-shi, Yamagata 999-3792, Japan
nomotatsu@jichi.ac.jp
Received, March 13, 2007
Accepted, April 18, 2007
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