Background: The mu-opioid agonist methadone is administered orally and used in opioid detoxification and in the treatment of moderate-to-severe pain. Acute oral methadone–use and –abuse have been associated with inflammatory and toxic central nervous system (CNS) damage in some cases and cognitive deficits can develop in long-term methadone users. In contrast, reports of intravenous methadone adverse effects are rare. Case presentation: Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid. Conclusion: This case suggests a potential bi-phasic primary toxic and secondary inflammatory CNS damage induced by intravenous methadone.
CITATION STYLE
Repple, J., Haessner, S., Johnen, A., Landmeyer, N. C., Schulte-Mecklenbeck, A., Pawlitzki, M., … Meyer zu Hörste, G. (2021). Intravenous methadone causes acute toxic and delayed inflammatory encephalopathy with persistent neurocognitive impairments. BMC Neurology, 21(1). https://doi.org/10.1186/s12883-021-02108-9
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