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.
Comparable studies
Other case reports and case series on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA Individuals whose deaths were associated with MDMA or MDEA use | 1987 | Case series | n = 5 |
| Pathology of deaths associated with "ecstasy" and "eve" misuse. Young white men aged 20 to 25 who died after using ring-substituted amphetamines (MDMA... | 1996 | Case series | n = 7 |
| 'Eve' and 'Ecstasy' Individuals who died after using MDMA or MDEA | 1987 | Case series | n = 5 |
| A Method of Conducting Therapeutic Sessions with MDMA Clients with clear therapeutic purpose, excluding those with serious functional... | 1998 | Case study | n = 2 |
| Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) Psychiatric patients presenting between 1990 and 1992 whose symptoms developed in the... | 1994 | Case series | n = 13 |
Citations in the library
Cites 6
- A review on the mitochondrial toxicity of “ecstasy” (3,4-methylenedioxymethamphetamine, MDMA) Current Research in Toxicology May 27, 2022
- Hepatic injury and hepatic failure adverse events in 3,4-methylenedioxymethamphetamine users reported to the FDA Adverse Event Reporting System. Frontiers in Psychiatry 2024
- A Case of Ecstasy-Induced Acute Hepatic Injury. Cureus October 2022
- MDMA-Associated Liver Toxicity: Pathophysiology, Management, and Current State of Knowledge. AACN advanced critical care 2019
- Mechanisms underlying the hepatotoxic effects of ecstasy. Current Pharmaceutical Biotechnology August 1, 2010
and 1 more in the library