Acute 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity Leading to Fulminant Hepatic Failure and Emergency Liver Transplantation

TL;DR

A young man suffered severe liver failure and needed a liver transplant after taking MDMA, showing the drug's potentially deadly effects.

Contribution

This case report documents a rare instance of MDMA-induced fulminant hepatic failure requiring emergency liver transplantation.

Findings

MDMA intoxication led to multiorgan failure, including severe liver damage and coagulopathy.

Aggressive treatment failed to reverse hepatic failure, necessitating urgent liver transplantation.

The patient survived and stabilized post-transplant with appropriate care.

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.

Figures