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In October, 2018, a middle-aged ethnic Karen* man from Burma was evaluated at a hospital emergency department with altered mental status, vomiting, diarrhea, incontinence, sweating, swelling of the lip and tongue, and excessive salivation. Signs and symptoms began approximately 2–3 hours after eating mushrooms at home. The patient was admitted for supportive treatment, including endotracheal intubation for airway protection and mechanical ventilation because of acute respiratory failure and hypoxia for 4 days. His daughter, who also ate the mushrooms, was evaluated for similar, but milder symptoms, including mild sweating and nausea; she was admitted overnight for observation, and was discharged the following day. The father recovered and was discharged 8 days after admission. An emergency department physician suspected possible cholinergic mushroom toxicosis and notified the Minnesota Poison Control System (MPCS). MPCS notified the Minnesota Department of Health (MDH), and, together with the Minnesota Mycological Society (MMS), they initiated an investigation. The patient’s medical records and exposure history were obtained and reviewed, and he was interviewed through a Karen language interpreter. He described the mushroom and collection location and later sent a photo of a mushroom that he said looked similar to the one he picked. He reported that he had picked mushrooms from an area near his workplace and cooked them in turmeric, oil, and water; only he and his daughter had eaten the mushrooms, and she reportedly consumed substantially fewer mushrooms than he did. He said this was the first time he had picked mushrooms since arriving in Minnesota in 2015 and that he had selected the mushrooms because they resembled the Ochre mushroom (Amanita hemibapha var. ochracea) from his native Burma. A site visit to the location where the mushrooms were picked identified one remaining mushroom that matched the patient’s description (Figure); an MMS mycologist examined the mushroom and identified it as Amanita muscaria var. guessowii. A. muscaria mushrooms can contain ibotenic acid and muscimol, which are structurally similar to glutamate and

Notes from the Field: Acute Intoxications from Consumption of Amanita muscaria Mushrooms — Minnesota, 2018