# Acute Toxic Cerebellar Leukoencephalopathy in an Eight-Year-Old Child Following Illicit Fentanyl and Cocaine Ingestion: A Case Report of Full Clinical Recovery

## TL;DR

An 8-year-old child who ingested illicit fentanyl and cocaine showed signs of brain damage but fully recovered within five days.

## Contribution

This case report documents a rare instance of acute toxic leukoencephalopathy in a child with full recovery.

## Key findings

- An 8-year-old child showed neurological symptoms consistent with opioid-induced leukoencephalopathy.
- All symptoms resolved within five days with no residual effects.
- Prompt recognition and treatment are crucial for preventing severe outcomes in children.

## Abstract

During the current opioid epidemic, the number of children with illicit toxic ingestions is increasing. Children presenting with altered mental status and neurologic, particularly cerebellar symptoms of unclear etiology, should be considered to undergo brain imaging as well as toxicology screening to not miss the possible complication of acute toxic leukoencephalopathy.

We report the case of an eight-year-old child who presented with somnolence and respiratory depression of unclear etiology, responding profoundly to naloxone, quickly raising concern for drug ingestion. The toxicology screen was positive for fentanyl, cocaine metabolites, caffeine, and diphenhydramine, but not available until day 3 of the hospital stay. In the interim, head CT and brain MRI findings revealed concerning bilateral cerebellar hypodensities, suggestive of opioid-induced leukoencephalopathy. This condition has been described as potentially malignant and fatal, but very few cases of this pathology have been described in children so far. Fortunately, all neurological symptoms in our patient, including altered mental status, respiratory depression, atactic gait, blurry vision, and lower extremity pain, completely resolved within five days of presentation and the patient seemingly underwent a full clinical recovery without residual symptoms.

Awareness and prompt recognition of acute toxic leukoencephalopathy in children presenting with altered mental status or neurological symptoms of unclear etiology is of utmost importance to prevent deterioration and optimize treatment, especially during times of a worsening opioid epidemic in our country.