Toxic Leukoencephalopathy in a Teenager Caused by the Recreational Ingestion of 25I-NBOMe: A Case Report and Review of Literature

Abstract

Over the past 5 years, the designer drug classification of illicit substances has gained the attention of law enforcement agencies, healthcare providers, and concerned parents around the world. These drugs are often marketed as safe and legal alternatives to their already banned counterparts and are easily acquired online, at head shops or behind the counter at local convenient stores. This new drug class includes synthetic cathinones, synthetic cannabinoids, and phenylethylamine derivatives of the 2C class of hallucinogens. Many of these drugs were created for animal research purposes only and were never intended for human consumption. As such, little is known about their pharmacokinetic, pharmacodynamics, and adverse effect profile. Variability in preparation may further alter the already unpredictable safety profile. We report an otherwise healthy 16-year-old adolescent who presented to the emergency department for worsening left-sided weakness, new onset seizure activity, changes in mental status, and an overall decline in health. He self-reported the recreational ingestion of 25I-NBOMe prior to admission. Magnetic resonance imaging and a brain biopsy performed during the course of his admission confirmed the diagnosis of toxic leukoencephalopathy secondary to synthetic hallucinogenic drug use. The basic pharmacology and end-organ effects of 25I-NBOMe are reviewed, their adverse effect profile is presented, and potential anesthetic implications are postulated.




J Med Cases. 2017;8(6):174-179
doi: https://doi.org/10.14740/jmc2811w