[Hair analysis in the diagnosis of toxic hepatitis after Ecstasy abuse]

A young man, aged 18 years, was admitted to hospital for suspected hepatitis, having developed increasing jaundice without any pain. His urine was light brown in colour and the stools often liquid and pale. Every 14 days for the last 4 months he had been taking 2 tablets of "ecstasy" (methylenedioxyamphetamine; MDMA). Physical examination was unremarkable and the patient was in good general condition.

The activities of GOT, GPT and alkaline phosphatase were raised (to 903, 744 and 270 U/l, respectively) as was the bilirubin concentration (16.8 mg/dl). Tests were negative for: leptospira and the viruses of mumps, HI, varicella zoster, picornavirus, cytomegaly, Coxsackie and hepatitis, A, B and C. Ultrasound revealed hepatomegaly, with a normal echo pattern. Hair analysis demonstrated, in two different hair segments (0-2 cm and 2-4 cm, respectively) both MDMA (6.4 and 4.3 micrograms/g hair) and its metabolite MDA (0.7 and 5.0 micrograms/g hair).

No specific treatment was required. After intake of the drug had been stopped the transferase activities and bilirubin concentration became essentially normal.

Hair analysis can be valuable in confirming "ecstasy" abuse, especially when it is denied, and thus contribute to clarifying the cause of toxic hepatitis.