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Acute kidney injury (AKI) secondary to toxin exposure is an uncommon but potentially life-threatening condition, particularly when associated with multisystem involvement. Psilocybin-containing mushrooms, also known as "magic mushrooms", are generally considered to have low systemic toxicity; however, rare cases of severe complications have been reported.
This case describes a middle-aged male with prior cardiovascular comorbidities and a history of recreational drug use who developed severe anuric AKI requiring dialysis following ingestion of magic mushrooms in combination with other substances. His course was complicated by supraventricular tachycardia (SVT), markedly elevated cardiac biomarkers, and severe left ventricular dysfunction suggestive of myocarditis. Subsequent imaging demonstrated extensive arterial thrombosis, leading to renal infarction and pulmonary embolism.
Despite intensive multidisciplinary management, the clinical course was progressive and ultimately fatal. This case highlights the potential for life-threatening complications from polysubstance use and underscores the need for heightened clinical vigilance regarding toxin-induced organ injury and prothrombotic states.
The patient reported:
Symptoms began within hours after ingestion of magic mushrooms along with alcohol and lysergic acid diethylamide (LSD) that progressively worsened.
Introduction
Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine; 4-PO-DMT) belongs to the class of naturally occurring tryptamine alkaloid. It is found in more than 200 mushroom species, mainly from the genera Panaeolina, Panaeolus, Conocybe, Gymnopilus, Stropharia, Psilocybe, and Pluteus. It has a long history of usage in Indigenous spiritual and ceremonial practices and is now gaining attention for its psychoactive properties and potential therapeutic applications.
After ingestion, psilocybin is quickly converted to psilocin, a serotonergic compound structurally same to serotonin. Psilocin acts primarily as a partial agonist at serotonin receptors, especially the serotonin 2A receptor (5-HT2A), altering activity in brain regions such as the prefrontal cortex and amygdala. This leads to effects including euphoria, visual and auditory hallucinations, perceptual changes, time distortion, and spiritual experiences.
Psilocybin-containing (“magic”) mushrooms are increasingly employed in both recreational settings and controlled therapeutic contexts due to their psychoactive effects. Available evidence from case series and toxicology reviews indicates that adverse events are most often neuropsychiatric, transient, and self-limiting, with serious systemic toxicity considered uncommon. However, rare but clinically significant reports have described the development of AKI following ingestion of hallucinogenic mushrooms, with some cases progressing to severe renal impairment requiring renal replacement therapy.
History
The patient was a middle-aged male with significant cardiovascular and metabolic comorbidities, including:
He reported:
There was:
The combination of polysubstance exposure and underlying vascular disease constituted a high-risk clinical background.
The patient was oligoanuric for approximately 4 days prior to hospital admission and remained anuric during hospitalization.
(a) Laboratory investigations
(b) Transthoracic echocardiography
(c) Computed tomography imaging
(d) Additional workup
Discussion
This case shows a rare but severe form of toxin-related multiorgan injury. While most cases of psilocybin exposure are mild, this patient developed kidney failure, cardiac dysfunction, and widespread thrombosis.
Underlying vascular disease and prior substance use may have increased susceptibility to severe complications. The extent of thrombosis and organ damage is not typical for toxin-related AKI, which is often reversible.
Despite appropriate supportive and targeted treatment, the patient’s condition worsened, indicating a poor prognosis in such presentations.
Key learnings
Cureus
Acute Kidney Failure and Myocarditis Triggered by Magic Mushroom Toxicity in a Patient With Prior Cocaine Exposure
Aung Phyo Oo et al.
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