Death cap (lat. Amanita phalloides) is generally considered the most toxic known mushroom. Amatoxins (the main toxin being α-amanitin), which death cap produces, are the most toxic cyclopeptides. They cause liver, renal and central nervous system damage. Within the cell they bind to the RNA-polymerase II and inhibit DNA transcription. The result is the arrest of cell’s protein synthesis. The three-phase clinical course is characteristic: the first phase consists of gastrointestinal toxicity, the second is represented by transient improvement and the third one is characterized by late onset hepatic failure and renal failure. The case report represents a 30-year-old female with severe death cap poisoning. α-amanitin caused acute hepatic failure and related complications, which almost required liver transplantation. With the help of intensive treatment we avoided the need for transplantation and enabled the patient’s full recovery.