Persistent neuropsychiatric dysfunction following chronic tiletamine-containing e-cigarette use: a case report

Tiletamine is a dissociative anesthetic used in veterinary medicine and has recently emerged as a potential illicit additive in e-cigarettes after regulation of etomidate. However, reports of chronic tiletamine-containing e-cigarette use remain scarce. We report the case of a 22-year-old man who developed progressive gait instability, dysarthria, choking on drinking, hand tremor, emotional instability, and marked craving after chronic use of tiletamine-containing e-cigarettes. Brain MRI and routine electromyography showed no definite structural abnormalities, whereas electroencephalography and blink reflex testing suggested functional brain involvement. After discontinuation of tiletamine-containing e-cigarettes and comprehensive treatment, his neurological symptoms, emotional symptoms, and craving gradually improved, with sustained improvement at 1-month follow-up. This case suggests that chronic tiletamine abuse via e-cigarettes may cause persistent neuropsychiatric dysfunction beyond the acute intoxication pattern described in previous reports and may also be accompanied by dependence-related features.