Breast milk-associated mushroom poisoning in a toddler: a case report

BACKGROUND: Mushroom poisoning represents a significant global public health concern, particularly in endemic regions with abundant wild mushroom resources. While the pathophysiological mechanisms of acute poisoning through direct ingestion are well-characterized, the potential for secondary poisoning via breast milk remains poorly understood, with only isolated case reports documented in medical literature. This knowledge gap presents considerable challenges for the prevention, diagnosis and treatment of mushroom toxicity in breastfed toddlers. CASE PRESENTATION: We present a suspected case of a 2-year-8-month-old girl who elevated liver enzymes (AST 64 U/L, ALT 46 U/L), and gastrointestinal symptoms within 20 hours after breast milk from her mother who had consumed wild mushrooms containing amatoxins. The child achieved complete recovery following standard treatments including activated charcoal administration, gastric lavage, and supportive care. DISCUSSION: This report provides compelling evidence for toxin transmission through breast milk and highlights the diagnostic challenges posed by nonspecific presentations and limited detection methods in pediatric cases. Clinicians evaluating toddlers with unexplained hepatogastrointestinal symptoms, particularly in mushroom-endemic regions, should maintain high suspicion for secondary poisoning and immediately discontinue breastfeeding following maternal toxin exposure. Our findings emphasize the need for evidence-based guidelines for managing breastfeeding mothers with potential mushroom toxin exposure and call for further research on breast milk transmission mechanisms and optimal breastfeeding cessation duration.