A case of reversible encephalopathy accompanied by demyelination occurring after ingestion of sugihiratake mushrooms

Abstract

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.