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Updated: May 6, 2026

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Novel Cause of Reversible Leukoencephalopathy in an Infant Associated With Illicit Fentanyl Exposure

Emin Fidan1, Apurva Devaraj1, Radha Giridharan1

  • 1Division of Child Neurology, SUNY Downstate Health Sciences University and Kings County Hospital, Brooklyn, New York, USA.

Journal of Child Neurology
|June 23, 2025
PubMed

Insights

Accidental fentanyl exposure in infants can cause severe health issues, including respiratory failure and altered mental status. Prompt diagnosis and management are crucial for preventing long-term neurological damage in children.

Area of Science:

  • Pediatric toxicology
  • Neurology
  • Emergency medicine

Background:

  • Illicit fentanyl use leads to increased mortality and morbidity.
  • Children are vulnerable to accidental fentanyl exposure.
  • Fentanyl exposure can cause severe acute health problems in infants.

Purpose of the Study:

  • To present a case of accidental fentanyl exposure in an infant.
  • To highlight the diagnostic challenges and management strategies.
  • To emphasize the importance of early intervention for preventing neurological sequelae.

Main Methods:

  • Case report of a 12-month-old infant with symptoms of fentanyl toxicity.
  • Urine toxicology screening for fentanyl.
  • Magnetic Resonance Imaging (MRI) of the brain to assess neurological damage.
  • Clinical monitoring and follow-up.

Main Results:

  • The infant presented with hypothermia, hypoxic respiratory failure, altered mental status, and metabolic acidosis.
  • Fentanyl was detected in the infant's urine.
  • Brain MRI revealed white matter abnormalities.
  • The infant recovered with appropriate management and showed significant improvement on follow-up MRI and clinical examination.

Conclusions:

  • Accidental fentanyl exposure in infants requires urgent medical attention.
  • Timely diagnosis and management can lead to favorable neurological outcomes.
  • This case underscores the critical need for awareness and preventative measures regarding pediatric fentanyl exposure.

Keywords:
fentanylinfantintoxicationleukoencephalopathy

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