A 40 y.o. male ate some mushrooms he found in the woods in spring. He developed ataxia and abdominal pain.

what did he eat?

true morels

Our patient ate true morel mushrooms.

In 2023. 51 illnesses were reported after eating true morels (Morchella sextelata)at a Montana restaurant.  It was determined in the investigation that the morels were poorly cooked. While most individuals had abdominal pain and GI distress, two people died. The conclusion was that all morels need to be cooked thoroughly before eating. In general,  cooked morel mushrooms are considered a delicacy and sell for 60 to 100 dollars a pound.  

The neurologic syndrome produced by morel mushrooms(Morchella)  is distinct from false morel toxicity . The true morels neurologic syndrome has been characterized by cerebellar signs (including tremor, dizziness,  unsteadiness and ataxia.

False morels are commonly cited as a cause of mushroom poisoning. The cap of a false morel does not attach directly to the stem of the mushroom as shown below. If you slice the stem of a morel mushroom, it is hollow inside as opposed to the solid stem of the false morel.

false morel on the L two mushrooms with the true morel on the R

False morels are more often associated with toxicity because they contain gyromitrin. This is converted to monomethylhydrazine(MMH). MMH is a common rocket propellant and causes central nervous system toxicity  by blocking B6 synthesis and inhibiting GABA.Without neuro inhibition from GABA seizures can result. In addition,  heart failure, liver and kidney damage and death have been reported. Methemoglobinemia  and /or hemolysis  can appears 6-48 hours after eating  false morels.  The toxin is only partially broken down by high temperature and persists after cooking.

Another mushroom causing mortality  is the death cap mushroom( Amanita phalloides).  It is the most poisonous of all known mushrooms. It is thought to have killed the emperor Claudius and Holy Roman Emperor Charles VI in 1740.  

Amanita  contains amatoxins which are taken up by the liver where they begin to cause damage. They are then secreted by the bile into the blood where they are taken up by the liver again, causing a cycle of damage and excretion. In the liver, amatoxins inhibit RNA-polymerase II. The liver is slowly destroyed and is unable to repair itself due to the inactivation of the RNA-polymerase. Thus, the liver slowly dissolves with no hope of recovery. Once again these mushrooms can be difficult to distinguish from non toxic mushrooms like straw mushrooms especially in the puffball stage.

straw mushrooms vs amanita

Currently,  research is being proposed for “magic mushrooms” containing psilocybin.  These cause hallucinations and are being tested for the treatment of depression and PTSD. One Amanita species, Amanita muscari, also causes hallucinations but they are caused by muscimol.

psilocybin containing mushrooms

Our patient was hydrated and recovered successfully.

FUN FACTS

The Wood Wide Web is an amazing system connecting mycelium of fungi and trees.  Mushrooms live in symbiosis with trees. The fungi benefit by receiving 30% of photosynthesized sugars of the tree  and the trees receive water and nutrients like phosphorous and nitrogen. Morels in particular are associated with dying trees like apple, elm and ash.  The dying trees provide carbon rich nutrients like lignin and cellulose.

If you are ready to go hunting mushrooms, spring is a good time; test yourself with the mushroom quiz in the last reference first.

US Food and drug administration.  Investigation of illnesses: morel mushrooms May 2023

Tesfai A, Hinnenkamp R, Weed B, et.al. Understanding the potential risks of consuming raw morel mushrooms: challenges and lessons learned from a recent outbreak linked to raw morel mushrooms. Food Prot Trends. 2025 May 1;45(3):222-227.

Lagrange E, and Vernoux J-P. 2020. Warning on false or true morels and button mushrooms with potential toxicity linked to hydrazinic toxins: an update. Toxins 12:482.

The Underlands by Robert McFarland

https://mushroomexam.com/mushroom_look_alikes.html#:~:text=Death%20cap%20(Amanita%20phalloides)%20%2D,and%20when%20young%20a%20puffball.