Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
Am J Ther. 2014 Jul-Aug;21(4):e117-9. doi: 10.1097/MJT.0b013e3182583b8d.
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°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.
N-甲基-3,4-亚甲二氧基苯丙胺（MDMA），也被称为“摇头丸”，是美国青少年中常见的滥用精神药物。我们报告了一位 23 岁的韩裔美国女性的病例，她在摄入摇头丸后出现癫痫发作、谵妄和僵硬。她发热（38.7°C）、心动过速（188 次/分）、呼吸急促（26 次/分），血压临界（95/43mmHg）。检查发现全身肌肉僵硬、震颤、反射亢进和眼球阵挛，导致诊断为血清素综合征。尿液毒理学筛查仅对安非他命呈阳性，与 MDMA 摄入史一致。初始实验室检查显示血小板减少，进一步检查显示凝血酶原时间、部分凝血活酶时间、纤维蛋白原降低和 D-二聚体升高，提示弥散性血管内凝血。肝转氨酶显著升高反映急性肝炎。患者接受了支持性治疗，在入院第 3 天有所改善。MDMA 毒性表现为血清素综合征、肝炎和凝血功能障碍极为罕见。MDMA 由肝 CYP2D6 酶代谢。某些人群，如韩国人、中国人和日本人，存在一种导致酶活性降低的多态性的高发率。我们讨论了这一假设，认为这可能是导致我们的患者单次摄入后出现严重表现的原因。
