• Jennifer Xu, Shaylor Klein, Parmjyot Singh, Eric Wetzel, Neophytos Zambas, and Elizabeth Paterek.
• Jefferson Torresdale Hospital, Philadelphia, Pennsylvania. Electronic address: jxx104@jefferson.edu.
• J Emerg Med. 2024 Sep 5.

BackgroundMost mushroom exposures are benign and rare, with approximately 7400 yearly exposures. Of these, less than 1% of annual exposures can be attributed to cyclopeptide-containing mushrooms, amatoxins, and phallotoxins, with improved outcomes with early recognition. Notably, toxic ingestion of Amanita genus mushrooms is a rare but notable cause of acute liver failure. Approximately 95% of deaths worldwide associated with mushroom ingestion have been caused by amatoxin, the causative agent found in these mushrooms.Case SeriesWe present a case series involving eight family members, aged 8-44 years old, who shared a meal of these mushrooms foraged from the greater Northeast Philadelphia area. These individuals developed symptoms 8 hours postingestion and presented to the emergency department 16 hours postingestion. Three of them developed acute liver injury, and all recovered without the need for liver transplantation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases required a great deal of resources, including uncommonly utilized medications, active resuscitation, a thorough timeline investigation, and complex collaboration with pediatrics, toxicology, and a liver transplant-capable center. This community hospital involved logistical and supply challenges, including limited emergency department space, depletion of activated charcoal, and appropriate disposition despite relatively benign presentation.Copyright © 2024 Elsevier Inc. All rights reserved.

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