Disulfiramlike Mushroom Toxicity Clinical Presentation

Updated: Apr 20, 2015
  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD  more...
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History of mushroom ingestion is helpful. Raw and cooked mushrooms as well as the cooking water are capable of producing toxicity through ALDH inhibition. Symptoms begin within minutes of ethanol ingestion. 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.

  • 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


Findings on physical examination may include the following:

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


An association with ethanol always exists, although ethanol use may be unintentional (eg, cough syrup).