Too Hot to Handle: A Case Report of Extreme Pyrexia After MDMA Ingestion

Hyperpyrexia is a well-documented adverse effect of 3,4-methylenedioxymethamphetamine (MDMA) and is associated with a poor prognosis. There are currently limited published records of patients surviving a pyrexia of or greater than 43°C after MDMA intake. Rapid cooling and multiorgan support in an intensive care setting may offer patients the best chance of recovery. We present the case of a 16-year-old male who was admitted to our tertiary, adult intensive care unit (ICU) for unrecordable pyrexia (>43°C) after reported ecstasy intake. The patient went on to develop severe multiorgan failure and profound disseminated intravascular coagulopathy. Initial patient management focused on rapid cooling using an endovascular cooling catheter and rigorous monitoring and treatment of autonomic symptoms, followed by subsequent surgical therapy (fasciotomy) and multiorgan support. The patient eventually achieved a good clinical outcome after 4 weeks of management in the ICU, and was discharged well to his local hospital. Despite multiple end-organ dysfunctions and often severely poor prognosis, survival after severe hyperpyrexia induced by MDMA intake is possible with proper management and organ support in an appropriate intensive care environment.