Delayed presentation of familial amatoxin mushroom poisoning with markedly heterogeneous outcomes treated with haemoperfusion and plasma exchange: A case series from Vietnam.

Amatoxin-containing mushroom poisoning remains one of the most severe causes of toxic acute liver injury worldwide. Delayed hospital presentation is associated with poor prognosis and increased mortality. Evidence regarding extracorporeal blood purification therapy, including haemoperfusion and therapeutic plasma exchange, remains limited, particularly in resource-limited settings. We report a familial cluster of four patients, representing a markedly delayed presentation. They demonstrated markedly heterogeneous clinical outcomes ranging from minimal biochemical abnormalities to fatal acute liver failure.