Life-threatening intoxications related to persistent MDMA (3,4-methylenedioxymethamphetamine) concentrations (2018)

Introduction: After a loss of interest from drug users, the use of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy), an illicit phenethylamine, is currently highly prevalent, especially in young peoples, for its stimulant and euphoric effects.
Methods: We report the cases of two young men who presented with life-threatening complications related to the occasional use of MDMA. The interest of these cases is related to persistent concentrations of MDMA.
Results: The first patient aged from 21 presented an ischemic stroke after the recreational consumption of MDMA. MDMA and metabolite (MDA) plasma concentrations measured 5 days after the consumption were 10.2 ng/mL and 2.3 ng/mL, respectively. The patient recovered with the persistence of a significant facial paralysis. The second patient aged of 19 years presented a multiple organ failure shortly after the recreational consumption of MDMA. The patient's clinical and biological state required dialysis and liver transplantation. MDMA and MDA plasma concentrations measured 3 days after the consumption were 133 ng/mL and traces, respectively. The evolution was favorable after liver transplantation, with persistent chronic kidney disease stage 2.
Conclusion: As shown in these two cases, plasma MDMA concentrations measured 3/5 days after the substance's consumption were particularly high suggesting whether a consumption of a large amount and/or a saturation of the hepatic/renal elimination mechanism. Therefore, since MDMA excretion from plasma can be delayed, complete toxicology screening including the measurement of MDMA concentrations should be considered in the presence of any suspicion of MDMA intoxication.