Prolonged paranoid psychosis after Amanita muscaria ingestion

Amanita muscaria contains ibotenic acid, muscimol, muscazone and other toxins such as muscarine. Ibotenic acid acts on glutamic acid receptors and has an excitatory action. On the other hand, muscimol acts on GABA receptors and has a depressant action. The concentration of muscimol increases with time due to ibotenic acid decarboxylation into muscimol. Muscazone and muscarine exhibit minor pharmacological activity. The duration of clinical manifestations after Amanita muscaria ingestion does not exceed 24 hours. We report on 5-day-long paranoid psychosis after Amanita muscaria ingestion due to a bet on mushroom species. A 48-year-old man, with no previous medical history, gathered and ate mushrooms presumed to be Amanita caesarea for dinner after making a bet with a friend about mushroom species. Half an hour later he started to vomit and fell asleep. He was found comatose having a seizure-like activity and soiled after having urinated and defecated three hours after ingestion.