Three cases of wood-lover paralysis: clinical insights from Victoria, Australia.

Abstract

<h4>Introduction</h4>Wood-lover paralysis is a rare complication of <i>Psilocybe</i> mushroom ingestion. The clinical spectrum is poorly characterized and published cases remain limited.<h4>Case presentations</h4>We describe three patients who developed acute muscle weakness following ingestion of <i>Psilocybe</i> mushrooms in Victoria, Australia. Written informed consent was obtained from these patients for publication of this case series.<h4>• case 1</h4>Mild generalized weakness affecting gait, without other end-organ involvement.<h4>• case 2</h4>Severe generalized weakness involving upper and lower limbs, associated with takotsubo cardiomyopathy.<h4>• case 3</h4>Severe generalized weakness with respiratory failure, requiring intubation.All patients had a clear temporal relationship between mushroom ingestion and symptom onset. Mushroom samples from Cases 2 and Case 3 were identified as <i>Psilocybe subaeruginosa</i> based on DNA sequence data. Serum toxicology detected psilocin in Case 1 and Case 3.<h4>Discussion</h4>Our findings support a causal role for <i>Psilocybe subaeruginosa</i>; however, no specific alkaloid has yet been proven to cause wood-lover paralysis.<h4>Conclusion</h4>These cases highlight the variable severity of wood-lover paralysis, ranging from mild weakness to life-threatening respiratory compromise, and add significantly to the current body of literature on this topic.

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