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Toxic leukoencephalopathy due to transdermal fentanyl overdose

Lindsey Foy1, Desiree M Seeyave, Stuart A Bradin

  • 1Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.

Pediatric Emergency Care
|September 20, 2011
PubMed

Insights

A toddler presented in a coma due to a fentanyl patch, showing rare brain MRI changes. Despite the severity, she had a good neurologic outcome, highlighting thorough examination importance.

Area of Science:

  • Pediatric Neurology
  • Toxicology
  • Emergency Medicine

Background:

  • Altered mental status in children presenting to the emergency department necessitates a broad differential diagnosis.
  • Opioid intoxication is a critical consideration in pediatric cases of altered mental status.
  • Prompt diagnosis and management are crucial for improving outcomes in pediatric poisoning.

Observation:

  • A 19-month-old female presented with coma and a fentanyl patch discovered adhered to her back.
  • Brain magnetic resonance imaging revealed changes consistent with toxic spongiform leukoencephalopathy.
  • The patient experienced a good neurologic recovery despite the severe presentation.

Findings:

  • Fentanyl intoxication can lead to toxic spongiform leukoencephalopathy, a rare but serious condition.
  • The case demonstrates an unusual MRI finding in opioid toxicity.
  • Despite typically poor prognoses, good neurologic outcomes are possible with prompt intervention.

Implications:

  • This case underscores the critical importance of a comprehensive physical examination in diagnosing pediatric coma.
  • It highlights a rare MRI finding associated with opioid intoxication, expanding the understanding of its neurological effects.
  • Physicians should consider opioid exposure in the differential diagnosis of pediatric altered mental status, even with unusual presentations.

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