Severe 3,4-Methylenedioxymethamphetamine (MDMA)-Associated Rhabdomyolysis in Crohn's Disease: Direct Toxicity and Inflammatory Susceptibility in the Absence of Hyperthermia.
Sebastian Hernandez Mejia, Aishwarya Ashwinee, Ranwa Aldaker
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 45-year-old man |
| Intervention | MDMA |
| Dose | 1.5 g |
| Topics | MDMA |
| Keywords | 4-Methylenedioxymethamphetamine MDMA Acute kidney injury Chron's disease Inflammatory bowel disease Inflammatory myopathy MDMA Toxicity Mitochondrial dysfunction Recreational drug use |
| Key findings | Severe MDMA-associated rhabdomyolysis and acute kidney injury can occur without hyperthermia, possibly through direct mitochondrial and oxidative muscle injury, and may be amplified by underlying Crohn's disease. |
Abstract
Rhabdomyolysis is a recognized complication of 3,4-methylenedioxymethamphetamine (MDMA), usually driven by severe hyperthermia and agitation. We describe a previously healthy 45-year-old man who developed profound rhabdomyolysis (creatine kinase (CK) 160,000 U/L) and intrinsic acute kidney injury requiring hemodialysis after ingesting 1.5 g of "Molly" (pure MDMA), despite remaining afebrile throughout. In the literature review, the first reported case of severe MDMA-associated rhabdomyolysis without hyperthermia and the third-highest CK values was documented. He later received a new diagnosis of Crohn's disease, raising the possibility that inflammatory bowel disease-related myositis created an "immune-primed" susceptibility to muscle injury. In contrast to typical MDMA cases, there was no hyperthermia, exertion, serotonin syndrome, or significant electrolyte abnormality to explain the muscle breakdown. This case, therefore, supports an under-recognized, non-hyperthermic mechanism of MDMA toxicity involving direct mitochondrial and oxidative skeletal muscle injury, potentially amplified by occult Crohn's disease, and highlights the need to consider MDMA toxicity even in afebrile patients presenting with severe rhabdomyolysis.
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 15
- Human Pharmacology of MDMA Therapeutic Drug Monitoring March 19, 2004
- MDMA enhances emotional empathy and prosocial behavior Social Cognitive and Affective Neuroscience October 4, 2013
- Pharmacology of MDMA in Humans Annals of the New York Academy of Sciences September 1, 2000
- In Vivo Imaging of Cerebral Serotonin Transporter and Serotonin2A Receptor Binding in 3,4-Methylenedioxymethamphetamine (MDMA or “Ecstasy”) and Hallucinogen Users Archives of General Psychiatry June 6, 2011
- Mechanisms of MDMA (Ecstasy)-Induced Oxidative Stress, Mitochondrial Dysfunction, and Organ Damage Current Pharmaceutical Biotechnology June 27, 2010
and 10 more in the library