PMID- 22713531
OWN - NLM
STAT- MEDLINE
DCOM- 20150302
LR  - 20221207
IS  - 1536-3686 (Electronic)
IS  - 1075-2765 (Linking)
VI  - 21
IP  - 4
DP  - 2014 Jul-Aug
TI  - Serotonin syndrome, disseminated intravascular coagulation, and hepatitis after a 
      single ingestion of MDMA in an Asian woman.
PG  - e117-9
LID - 10.1097/MJT.0b013e3182583b8d [doi]
AB  - N-Methyl-3,4-methylenedioxyamphetamine (MDMA), also called "Ecstasy," is a 
      commonly abused psychoactive drug among the American youth. We present the case 
      of a 23-year-old Korean-American woman who presented with seizure, delirium, and 
      rigidity after MDMA ingestion. She was febrile (38.7 degrees C), tachycardic (188 
      beats/min), tachypneic (26 breaths/min) with a borderline blood pressure (95/43 
      mm Hg). Examination revealed generalized muscle rigidity, tremors, hyperreflexia, 
      and ocular clonus, leading to the diagnosis of serotonin syndrome. Urine 
      toxicology screen was only positive for amphetamines, consistent with the history 
      of MDMA ingestion. Initial laboratory testing showed thrombocytopenia, further 
      testing showed deranged prothrombin time, partial thromboplastin time, decreased 
      fibrinogen, and elevated D-dimer, suggesting disseminated intravascular 
      coagulation. Hepatic transaminases trended up dramatically reflecting acute 
      hepatitis. The patient received supportive care and improved by hospital day 3. 
      MDMA toxicity manifested as serotonin syndrome, hepatitis, and coagulopathy is 
      exceedingly rare. MDMA is metabolized by the hepatic CYP2D6 enzyme. Certain 
      populations, such as Koreans, Chinese, and Japanese have a high prevalence of a 
      polymorphism that confers reduced enzyme activity. We discuss this hypothesis as 
      a possible cause for this severe presentation in our patient after a single 
      ingestion.
FAU - Nadkarni, Girish N
AU  - Nadkarni GN
AD  - Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University 
      College of Physicians and Surgeons, New York, NY.
FAU - Hoskote, Sumedh S
AU  - Hoskote SS
FAU - Piotrkowski, Jared
AU  - Piotrkowski J
FAU - Annapureddy, Narender
AU  - Annapureddy N
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Am J Ther
JT  - American journal of therapeutics
JID - 9441347
RN  - 0 (Hallucinogens)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP2D6)
RN  - KE1SEN21RM (N-Methyl-3,4-methylenedioxyamphetamine)
SB  - IM
MH  - Asian/genetics
MH  - Chemical and Drug Induced Liver Injury/*etiology
MH  - Cytochrome P-450 CYP2D6/genetics
MH  - Disseminated Intravascular Coagulation/*chemically induced
MH  - Female
MH  - Hallucinogens/adverse effects/metabolism
MH  - Humans
MH  - N-Methyl-3,4-methylenedioxyamphetamine/*adverse effects/metabolism
MH  - Polymorphism, Genetic
MH  - Serotonin Syndrome/*chemically induced
MH  - Young Adult
EDAT- 2012/06/21 06:00
MHDA- 2015/03/03 06:00
CRDT- 2012/06/21 06:00
PHST- 2012/06/21 06:00 [entrez]
PHST- 2012/06/21 06:00 [pubmed]
PHST- 2015/03/03 06:00 [medline]
AID - 10.1097/MJT.0b013e3182583b8d [doi]
PST - ppublish
SO  - Am J Ther. 2014 Jul-Aug;21(4):e117-9. doi: 10.1097/MJT.0b013e3182583b8d.