Case series: Alcohol intolerance with Coprine-like syndrome after consumption of the mushroom Lepiota aspera (Pers.:Fr.) Quél., 1886 (Freckled Dapperling).

Alcohol intolerance after consumption of wild mushrooms is a recognized phenomenon. This is best understood with Coprinus atramentarius. Its active component Coprine blocks enzymatic ethanol degradation at the stage of acetaldehyde, which is responsible for the well-recognized symptoms. Here, we report three events in five patients experiencing the same symptoms after consumption of self-collected Lepiota aspera. All had mistaken L. aspera for edible mushrooms as Amanita rubescens or Macrolepiota procera. In all events, L. aspera was identified by mycologists and no other mushrooms were involved. The mushrooms were well sautéed and tolerated well until an alcoholic beverage was consumed. Then within few minutes facial flushing, throbbing headache, tachycardia, and shortness of breath all occurred. The symptoms abated within a few hours with no sequelae but could be re-provoked by further alcohol consumption up to 48 h later. This syndrome appears to be identical with the one known from C. atramentarius. However, the toxin in L. aspera or its mechanism is not yet known.