Acute 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity Leading to Fulminant Hepatic Failure and Emergency Liver Transplantation
Marcus Vinícius de Aragão Batista, Miguel Barbosa, José Casimiro, César Vieira, Nuno Germano
Cureus December 20, 2025 DOI: 10.7759/cureus.99716 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Previously healthy 22-year-old man |
| Interventions | aggressive resuscitation continuous renal replacement therapy N-acetylcysteine infusion plasma exchange hemoadsorption orthotopic liver transplantation immunosuppression antimicrobial prophylaxis |
| Duration | 5 days to transplantation, followed by postoperative stabilization |
| Topics | MDMA |
| Keywords | Rhabdomyolysis Fulminant hepatic failure Liver transplantation Immunosuppression Toxicity Renal replacement therapy Sepsis Acute kidney injury Gastroenterology Hepatic dysfunction Intensive care medicine Intensive care unit Organ dysfunction Acute hepatic failure Multiorgan failure Disseminated intravascular coagulation Complication Liver injury |
| Key findings | MDMA intoxication can cause fulminant hepatic failure and multiorgan dysfunction, and timely liver transplantation may ensure survival. |
Abstract
Recreational use of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") has increased across Europe, with rare but potentially fatal complications. We report a case of fulminant hepatic failure and multiorgan dysfunction following acute MDMA intoxication in a previously healthy 22-year-old man. One hour after ingestion, he developed seizures, hyperthermia (43 °C), and cardiovascular collapse. Laboratory results revealed severe metabolic acidosis, rhabdomyolysis (creatine kinase (CK) >360 000 U/L), acute kidney injury, disseminated intravascular coagulation, and rapidly progressive hepatic necrosis (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >3000 U/L, factor V <5%). Despite aggressive resuscitation, continuous renal replacement therapy, N-acetylcysteine infusion, plasma exchange, and hemoadsorption, hepatic failure progressed. On day 5, urgent orthotopic liver transplantation was performed. Postoperatively, immunosuppression and antimicrobial prophylaxis were initiated, and the patient gradually stabilised. This case highlights the potential for catastrophic systemic toxicity from MDMA, the importance of early recognition, intensive support, and the role of timely liver transplantation in ensuring survival.