Toxic Fungi of Western North America

by Thomas J. Duffy, MD

The pathologic picture of amanitins

The pathologic picture reflects the attack of amatoxins on numerous tissues, principally by inhibiting RNA polymerase II in cell nuclei. In addition to the liver, pathologic findings may also include small hemorrhages in the tissues and cloudy swelling in the cells of the pancreas, adrenal glands, kidneys, heart, lungs, muscles, intestines and brain. Cardiac muscle occasionally shows fatty degeneration in addition to cloudy swelling. Swollen lymph nodes may occur. The central cells of the liver lobules regularly show fatty degeneration and destruction. Microscopy of a 1970 California fatality is included in the photo section at the end of this paper.

Liver
Figure 2. Liver cell necrosis in an amatoxin death

Heart
Figure 3. Cardiac muscle with cloudy swelling in same victim

Changes in the kidney glomeruli (the primary blood filter) may show mild enlargement. The kidneys often display cloudy swelling and destruction in the convoluted tubules near each glomerulus. (57)

Kidney
Figure 4. Kidney tubules & glomeruli in same victim as Figures 2,3