Spontaneous pneumomediastinum after oral ingestion of ecstasy

We describe a 23 year old male who presented with sudden onset of facial swelling, nasal tone of voice and shortness of breath after taking eight tablets of ecstasy. He was found to have surgical emphysema and pneumomediastinum. Though spontaneous pneumomediastinum is well known in inhalation drug users who try to enhance alveolar resorbtion with repeated Valsalva manouvre, it is rather unusual to see it after oral ingestion of ecstasy. The probable causative event is the prolonged and excessive physical exertion involved in dancing at a "rave". Acute physicians should be aware of the association and of its usually benign nature.