Neurotoxicity associated with the medicinal mushroom product-Diamond Shruumz: A case report

Medicinal mushrooms are widely available as health supplements, and the federal government does not currently require these products to be examined for quality and contents. This places consumers at risk for unintentional ingestion of other substances, including toxic mushroom species. We describe a case report of an ingestion of an edible medicinal mushroom product likely contaminated with muscimol, the primary toxin of <i>Amanita muscaria</i>. A 17-year-old female presented with altered mental status, mydriasis, salivation, and myoclonic jerks that were refractory to benzodiazepines. She was intubated for airway protection and had spontaneous improvement of all her symptoms with return to baseline within 8 hours of presentation. She disclosed ingestion of the chocolate bar brand "Diamond Shruumz" that has been recalled for muscimol contamination. She was discharged home the day after presentation without symptom recurrence. This case displays the toxidrome of muscimol ingestion consistent with prior reports in the literature from muscimol containing mushroom ingestion. To our knowledge, this is among the first reports of <i>Amanita muscaria</i> ingestion from a commercially available medicinal mushroom product.