PMID- 31240069
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1925-3621 (Electronic)
IS  - 1925-3621 (Linking)
VI  - 8
IP  - 3
DP  - 2018 Sep
TI  - 3,4-Methylenedioxymethamphetamine (MDMA, Ecstasy) Intoxication in a Young Adult 
      with Giant Coronary Aneurysms from Kawasaki Disease.
PG  - 752-762
LID - 10.1177/1925362118797751 [doi]
AB  - Kawasaki disease is an acute vasculitis of unknown etiology that usually occurs 
      in children less than five years old. Coronary artery aneurysm due to arteritis 
      is the most common cardiac complication. Chronic aneurysms are associated with an 
      increased risk of developing luminal thrombosis and ischemic myocardial injury. 
      We present a case of an 18-year-old male with a history of Kawasaki disease 
      complicated by chronic giant aneurysms of the right and left coronary arteries. 
      Serial echocardiographic studies and treadmill electrocardiogram stress tests as 
      recent as 1.5 years before death revealed excellent cardiac function by clinical 
      criteria. The decedent sustained a witnessed collapse after ingesting 
      3,4-methylenedioxymethamphetamine (MDMA) and ethanol. He was pronounced dead in 
      the emergency department after unsuccessful resuscitative efforts. Autopsy 
      revealed large aneurysms of the three main epicardial coronary arteries with 
      extensive foci of severe stenosis by intimal fibrosis and organizing thrombus. 
      Microscopic examination revealed multifocal severe myocyte hypertrophy. There 
      were remote microinfarcts in the anterior and posterior aspects of the left 
      ventricle and a recent, healing microinfarct in the posterior aspect of the left 
      ventricle. Toxicology examination of postmortem femoral blood revealed MDMA, 
      ethanol, and amiodarone. This case illustrates the residual, lasting effects of 
      cardiac disease due to Kawasaki disease and a potential complication in the 
      setting of use of an illicit stimulant, MDMA, an amphetamine derivative that 
      produces sympathetic activation and cardiovascular effects including tachycardia, 
      vasoconstriction, dysrhythmias, and coronary artery spasm. Kawasaki 
      disease-related abnormalities of the heart likely resulted in a lower threshold 
      for developing a fatal cardiac dysrhythmia under the circumstance of stimulant 
      use.
FAU - Eigsti, Renee
AU  - Eigsti R
FAU - Firchau, Dennis J
AU  - Firchau DJ
FAU - Nashelsky, Marcus B
AU  - Nashelsky MB
LA  - eng
PT  - Case Reports
DEP - 20180831
PL  - United States
TA  - Acad Forensic Pathol
JT  - Academic forensic pathology
JID - 101596736
PMC - PMC6490579
OTO - NOTNLM
OT  - Forensic pathology
OT  - Kawasaki disease
OT  - MDMA intoxication
COIS- Disclosures & Declaration of Conflicts of Interest: The authors, reviewers, 
      editors, and publication staff do not report any relevant conflicts of interest
EDAT- 2019/06/27 06:00
MHDA- 2019/06/27 06:01
PMCR- 2019/08/31
CRDT- 2019/06/27 06:00
PHST- 2018/04/03 00:00 [received]
PHST- 2018/05/20 00:00 [accepted]
PHST- 2019/06/27 06:00 [entrez]
PHST- 2019/06/27 06:00 [pubmed]
PHST- 2019/06/27 06:01 [medline]
PHST- 2019/08/31 00:00 [pmc-release]
AID - 10.1177_1925362118797751 [pii]
AID - 10.1177/1925362118797751 [doi]
PST - ppublish
SO  - Acad Forensic Pathol. 2018 Sep;8(3):752-762. doi: 10.1177/1925362118797751. Epub 
      2018 Aug 31.