Case series of Chlorophyllum molybdites intoxication in Sicily: an "alien" mushroom species in Europe

Introduction. Mushroom poisoning is an important cause of intoxication worldwide. The toxic mechanism remains frequently unknown and the diffusion of non-endemic species may cause the emergence of new syndromes. An example is the widespread of Chlorophyllum molybdites in Sicily. Case series. Pavia Poison Centre was recently involved in the management of 10 intoxications caused by the ingestion of Chlorophyllum molybdites, which was not considered part of the Italian mycological species. The clinical syndrome was characterized by severe gastrointestinal symptoms. In paediatric or vulnerable patients, it may bring to hypovolemic shock that necessitate intensive support. The possibly confusion with amatoxins-containing mushrooms may complicate the management. Conclusions. Chlorophyllum molybdites is widespread on the oriental coast of Sicily and it could be confused with "parasol mushrooms". Cooperation between emergency physicians, clinical toxicologist and mycologist, supported by improving of laboratory tests, is essential for the appropriate clinical management. Climate changes and migration flows can interfere with the diffusion of new species and the development of novel syndromes.