A case of MDMA toxicity with unusual clinical and neuroradiological features

Abstract

The use of illicit substances is a growing concern in emergency medicine and results in an increasing number of hospital admissions and fatalities. MDMA (3,4-methylenedioxymethamphetamine) and LSD (lysergic acid diethylamide) are two such drugs which have similar physical and psychological effects and are normally detected in blood and urine testing within 24-48 hours of ingestion. We present a case of a 22-year-old man who was found unconscious and unresponsive. History suggested the ingestion of illicit substances within the past 24 hours; however, urine and blood toxicology screening was negative. The patient was initially diagnosed with and treated for meningoencephalitis; however, CSF findings were negative. During the patient's recovery, he developed upper motor neurone neurological signs with pupillary dilatation. An MRI scan of the head was performed which revealed unusual features consistent with toxic leukoencephalopathy, most likely as a result of illicit substance intake. Further history was acquired confirming that the patient had ingested MDMA and LSD. The patient's presentation and course of admission is presented, with the clinical features of MDMA toxicity and the finding of toxic leukoencephalopathy reviewed. © The Intensive Care Society 2014.