Cough elixir overdose causing toxic leuco-encephalopathy and serotonin syndrome

Area of Science:

• Neurology
• Toxicology
• Pharmacology

Background:

• Acute toxic leukoencephalopathy and serotonin syndrome are rare neurological complications.
• Their co-occurrence is infrequently documented.
• Both can be associated with drug and toxin exposure.

Observation:

• A 14-year-old boy presented with altered consciousness and autonomic dysfunction after ingesting excessive cough remedies.
• Brain MRI showed white matter lesions.
• The patient experienced rapid improvement with supportive care.

Findings:

• The clinical presentation, MRI findings, and drug exposure history suggested concurrent acute toxic leukoencephalopathy and serotonin syndrome.
• The cough remedies contained dextromethorphan, chlorphenamine, dichlorobenzyl alcohol, and amylmetacreson.
• Rapid resolution of symptoms and MRI abnormalities was observed.

Implications:

• Cough medication overdose can be hazardous, potentially causing serotonin toxicity and central nervous system white matter damage.
• Early recognition and prompt treatment are crucial for favorable outcomes.
• This case highlights the importance of considering combined neurological syndromes in overdose scenarios.