Beyond gastroenteritis: first evidence of systemic biochemical disturbances, predominantly coagulation dysfunction, in Neoboletus poisoning.

Mushroom poisoning is the leading foodborne illness in China, yet precise identification remains challenging. In August 2022 and June 2023, two poisoning epidodes involving Neoboletus species occurred in Yunnan Province. The first incident involved four adults (18-46 years) who consumed a single wild species; one individual developed abdominal pain, dizziness, and hyperhidrosis that resolved spontaneously within 1 h. The second incident involved a mixed wild mushroom meal consumed by four individuals; three developed vomiting and fatigue. Laboratory examination of the two male patients with higher intake revealed dose-dependent multi-system biochemical derangements, characterized by coagulation disturbance (markedly prolonged thrombin time TT, up to 37.5 sec), pancreatic/glucose dysregulation (hyperglycemia up to 11.3 mmol/L), and skeletal muscle involvement (elevated creatine kinase up to 239 U/L), along with mild hepatic (elevated transaminases and bilirubin) and renal/metabolic (hyperuricemia and bicarbonate disturbance) abnormalities. The severity of these abnormalities correlated positively with the estimated ingested dose. Morphological and phylogenetic analyses identified the causative species most likely as N. obscureumbrinus (first incident) and N. multipunctatus (second incident), which was co-ingested with Rugiboletus extremiorientalis. Notably, N. obscureumbrinus is traditionally consumed as an edible mushroom in Southwest and South China, yet the safety of the genus Neoboletus warrants further attention. This is the first detailed report of Neoboletus poisoning, documenting that N. multipunctatus can induce systemic biochemical disturbances-with significant thrombin time prolongation as the most notable finding-in a dose-dependent manner, underscoring the need for vigilant species-level diagnosis and comprehensive laboratory monitoring in suspected bolete poisonings.