Rapidly reversible multiorgan failure after ingestion of “Molly” (pure 3,4-methylenedioxymethamphetamine): a case report

A 24-year-old Hispanic man suffered a seizure and then developed acute kidney injury, respiratory failure requiring mechanical ventilation, and congestive heart failure after ingesting the street drug "Molly" (pure MDMA). Unlike previously reported cases of MDMA-related organ failure, this patient's rapid multiorgan failure did not appear to be linked to hyperthermia, rhabdomyolysis, or hyponatremia. He recovered quickly with supportive care and was discharged. The case illustrates that MDMA can cause organ failure through multiple mechanisms, and drug toxicity should be considered in patients with unexplained multisystem organ failure.

Study at a glance

Abstract

Introduction“Molly” is a street name for pure 3,4-methylenedioxymethamphetamine, an amphetamine derivative which acts by enhancing the release of neurotransmitters such as serotonin, dopamine and norepinephrine. This produces euphoria, increased sensory awareness and central stimulation that make it a popular club drug. Nevertheless, it is also associated with serious side effects. We report an unusual case of rapid multiorgan failure after ingestion of “Molly”. Unlike previously described patterns of 3,4-methylenedioxymethamphetamine-related organ failure, our case does not appear to be related to hyperthermia, rhabdomyolysis or hyponatremia.Case presentationA 24-year-old Hispanic man presented to our hospital with an episode of seizure and subsequently developed acute kidney injury, respiratory failure requiring mechanical ventilation and congestive heart failure after ingestion of “Molly”. He rapidly recovered with supportive care and was discharged home.ConclusionsThe spectrum of complications associated with 3,4-methylenedioxymethamphetamine is wide and patient presentation may vary. Moreover, there appears to be multiple mechanisms involved in organ failure. Drug toxicity should be suspected while evaluating a patient with multisystem organ failure of unclear etiology. Treatment is generally supportive sometimes requiring mechanical ventilation and hemodialysis. Nevertheless, complete reversal of organ failure can be expected.