Scleroderma mushroom poisoning in France (2000–2022): clinical patterns and early signals of a possible emerging mycotoxic syndrome

Abstract Mushroom poisoning caused by species of the genus Scleroderma (“earthballs”) is generally considered benign and limited to mild gastrointestinal symptoms. However, recent clinical observations suggest a wider spectrum of toxicity. This retrospective study analyzed 134 Scleroderma -related cases reported to French Poison Control Centers between 2000 and 2022, representing the largest national series to date. Most exposures were accidental, often due to confusion with edible puffballs or truffles. While the majority of patients remained asymptomatic or experienced only minor gastrointestinal effects, nine cases (7%) were of moderate or severe intensity. In addition to vomiting and abdominal pain, several patients presented neurological symptoms such as vertigo, transient consciousness disorders, or myoclonia, as well as cardiovascular abnormalities including hypotension, bradycardia, or tachyarrhythmia. Similar cases have been described in Germany and Japan, with no co-ingestion of other toxic species. Although the responsible compounds remain unidentified, the combination of digestive, neurological, and cardiovascular manifestations, together with geographically dispersed occurrence, meets several defining features of emerging mycotoxic syndromes. These findings suggest that Scleroderma poisoning may represent a new toxidromic entity deserving further toxicological and biochemical characterization.