Dynamic myocardial injury and variable hallucination latency in <i>Psilocybe keralensis</i> poisoning: a molecularly confirmed case series from China.

Abstract

<h4>Introduction</h4>Psychoactive <i>Psilocybe</i> spp. mushrooms pose significant public health risks. We report a cluster of <i>Psilocybe keralensis</i> poisonings in Chengdu, China, highlighting its unique clinical features and cardiovascular complications.<h4>Case series</h4>Four patients ingested 16-90 g of wild mushrooms (misidentified as an edible species, but later molecularly confirmed as <i>Psilocybe keralensis</i>). Prodromal symptoms (e.g., dizziness) emerged within 5-20 min, but the onset of hallucinations varied widely (10-180 min). All patients developed hypertension (systolic blood pressure >150 mmHg), with one patient exhibiting rapid blood pressure elevation to 182/110 mmHg at 4 h post-ingestion, which was accompanied by evidence of myocardial injury (peak cardiac troponin T concentration 188.70 pg/mL [reference range <14 pg/mL]) and transient mild skeletal muscle involvement (peak myoglobin concentration 127.3 ng/mL, which normalized by day 2). Supportive treatment (gastric lavage, intravenous ranitidine, and fluid therapy) led to full recovery without sequelae.<h4>Discussion</h4>We observed altered myocardial biomarkers following <i>Psilocybe keralensis</i> poisoning, which signals potential cardiovascular risks.<h4>Conclusion</h4>Future clinical research on psilocybin should prioritize cardiovascular comorbidity screening and implement cardiac monitoring for high-risk patients. We believe that public health education should emphasize that both traditional morphological identification methods and folk-based toxicity testing lack scientific basis; it must advocate avoidance of wild mushroom foraging, which is the most reliable prevention strategy.

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