Not a Disease of the Past: A Case Report of Heroin-Induced Toxic Leukoencephalopathy Causing Progressive Neurologic Decline

TL;DR

A woman who relapsed into heroin use developed severe neurological symptoms due to toxic leukoencephalopathy, showing that this condition can occur even after long-term abstinence.

Contribution

This case report adds to the understanding of heroin-induced toxic leukoencephalopathy as a cause of neurological decline.

Findings

Neuroimaging showed diffuse leukoencephalopathy in cerebellar white matter and internal capsules.

Heroin-induced toxic leukoencephalopathy was identified as the likely cause despite no intravenous use.

Infectious, autoimmune, and metabolic causes were less likely based on lab results.

Abstract

Toxic leukoencephalopathy is a rare neurological complication associated with various toxins, including inhaled heroin (“chasing the dragon”). We report a case of a 36-year-old female with a history of heroin dependence, in remission for seven years until a recent relapse, who presented with progressive deterioration in speech clarity, swallowing difficulty, and imbalance. Neuroimaging revealed diffuse leukoencephalopathy involving the cerebellar white matter and internal capsules, suggestive of heroin induced leukoencephalopathy. Laboratory evaluation was unremarkable, and infectious, autoimmune, and metabolic causes were considered less likely. This case highlights the importance of recognizing heroin-induced toxic leukoencephalopathy as a cause of subacute progressive neurological decline in patients with recent heroin use, even in the absence of intravenous administration.

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