Disulfiramlike Mushroom Toxicity Clinical Presentation

Updated: Apr 08, 2019
  • Author: Stephen L Thornton, MD; Chief Editor: Sage W Wiener, MD  more...
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Obtaining a history of mushroom ingestion is critical in evaluating a patient with a disulfiramlike exposure. Raw and cooked mushrooms as well as the cooking water are capable of producing toxicity through aldehyde dehydrogenase (ALDH) inhibition. As long as the ethanol is ingested after the mushroom, symptoms can begin within minutes or be delayed for several hours after ethanol ingestion. Note that ethanol use may be unintentional (eg, cough syrup).

Patients may relate symptoms to ethanol, not mushrooms. Ascertaining if other species of wild mushrooms were ingested concomitantly and the approximate elapsed time since ingestion is important.

Signs and symptoms of disulfiramlike exposure include [11] :

  • Flushing or blotching red rash (face, neck, thorax)
  • Sense of face and hand swelling
  • Diaphoresis
  • Palpitations/chest pain
  • Dyspnea/hyperventilation
  • Nausea/vomiting
  • Metallic taste
  • Headache
  • Vertigo/dizziness
  • Tingling paresthesias (perhaps due to hyperventilation)
  • Apprehension/sense of impending doom
  • Weakness

The duration of symptoms is generally brief, around 30 min, but occasionally can last up to 24 h.


Physical Examination

Findings on physical examination may include the following:

  • Hypertension
  • Hypotension
  • Tachycardia
  • Flushing, particularly of upper half of body (occasionally blotchy red rash of thorax and neck with facial erythema)
  • Diaphoresis
  • Confusion

Hypotension is less common than with disulfiram and coma is uncommon to rare. [11]