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

Introduction: Psychoactive Psilocybe spp. mushrooms pose significant public health risks. We report a cluster of Psilocybe keralensis poisonings in Chengdu, China, highlighting its unique clinical features and cardiovascular complications.

Case series: Four patients ingested 16-90 g of wild mushrooms (misidentified as an edible species, but later molecularly confirmed as Psilocybe keralensis). 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 (peaked 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.

Discussion: We observed altered myocardial biomarkers following Psilocybe keralensis poisoning, which signals potential cardiovascular risks.

Conclusion: 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.