Different histologic patterns of hepatic injury after amanita phalloydes poisoning

Introduction: fatal poisoning due to Amanita phalloydes is a rare event in forensic practice and its evaluation requires an accurate study of circumstantial, clinical, toxicologic and histologic data. Materials and methods: the authors present the histologic results of four cases of accidental lethal poisoning with Amanita phalloydes with different patterns of liver damage regarding the amount and distibution of hepatocellular necrosis. Three patients died after few days from the ingestion of the mushrooms, the fourth one survived for four monthes after a liver transplantation. Results and conclusions: the histologic examination of the liver showed microscopic foci of hepatocellular necrosis typical of Amanita phalloydes poisoning but very different regarding the site and the extension of the necrosis inside the three zones of the lobule and the amount of the liver parenchima injury. Forensic study of Amanita phalloydes poisoning cannot rely only on the histologic examination of the liver but also needs the evaluation of the classical clinical and biochemical parameters.