Have You Heard About Molly?

Abstract

Abstract only INTRODUCTION: Ecstasy, crystal, meth, and molly are street names for the club drug MDMA (3, 4-methylenedioxy-N-amphetamine). Molly refers to pure, unadulterated MDMA and as such has serious side effects. CASE PRESENTATION: A 24-year-old Hispanic man with a medical history of seizure disorder was brought to the emergency department after a witnessed episode of seizure. On day 2 of his hospitalization he became anxious, agitated, and complained of abdominal pain, diarrhea, and vomiting. Serum creatinine had increased from 1.4 to 8 and he was transferred to the ICU. (See table 1). In the ICU patient developed respiratory distress, hypoxia with saturation of 70%, fever of 102, a heart rate of 140, and BP of 163/104. He was intubated for hypoxic respiratory failure. Chest x-ray revealed bilateral infiltrates (Figure 1). Bronchoscopy with bronchoalveolar lavage was performed and patient was started on antibiotics for pneumonia. Echocardiogram showed an ejection fraction of 30% with wall motion abnormalities. Collagen vascular profile was negative. Hemodialysis was initiated for worsening renal failure. After 3 sessions of hemodialysis, oxygenation, urine output, and creatinine levels improved. The patient was extubated and further history revealed consumption several hours prior to symptom onset, of a street drug <<molly>> with alcohol, marijuana, and <<purple drank>>, the slang term for a drink containing codeine and promethazine. No further hemodialysis was required and repeat echocardiogram showed normalization of left ventricular function. He was discharged home on day 12 of hospitalization. DISCUSSION: Our patient presented with seizures followed by rapid multi organ failure. Differential diagnoses included overwhelming sepsis and collagen vascular diseases. Microbiology and serology did not support these diagnoses; however his entire presentation was explained by toxic effects of MDMA. MDMA toxicity is due to release of neurotransmitters such as serotonin, dopamine, and amphetamine causing hyperthermia, seizures, muscle breakdown leading to renal failure as well as cardiotoxicity leading to congestive heart failure, all of which were seen in our patient. Interestingly, the improvement in our patient's condition was as dramatic as his rapid decline. CONCLUSIONS: MDMA is abused in our community. It is important to consider drug intoxication when evaluating patients with increased sympathetic activity and multiple organ dysfunction