Gyromitra mushrooms

Gyromitra mushrooms

Overview

• Also known as "brain fungi"
• Fruit in the spring and early summer
• Frequently mistaken for morel mushrooms
• Inhibits formation of Vitamin B6 and GABA via hydrazine metabolite

Clinical findings

• GI upset, fatigue, muscle cramps
• Can present with refractory seizures due to GABA deficiency
• Hemolysis usually mild
• Rarely methemoglobinemia

Management

• Supportive care
• High dose pyridoxine for refractory seizures (5g IV initially)
• Avoid phenobarbital, especially in liver failure
• Methylene blue for severe methemoglobinemia
• Folinic acid supplementation (hydrazines inhibit MTHF production)