title: Toxic leukoencephalopathy due to transdermal fentanyl overdose.
abstract: Children with altered mental status who present to the emergency department have a broad differential diagnosis. We report a case of a 19-month-old girl who presented in coma and who was later found to have a fentanyl patch adhered to her back. She was found to have changes on brain magnetic resonance imaging consistent with a toxic spongiform leukoencephalopathy but had a good neurologic outcome. This case report illustrates the importance of a thorough physical examination in children in coma and a rarely reported magnetic resonance imaging finding that has been seen in opioid intoxication and is usually associated with severe morbidity and mortality.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Foy
authors.forename: Desiree M
authors.initials: DM
authors.lastname: Seeyave
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Bradin
mesh_terms: D000061:Accidents, Home; D000279:Administration, Cutaneous; D001049:Apnea / Q000139:chemically induced; D002675:Child, Preschool; D003128:Coma / Q000139:chemically induced; D003655:Decerebrate State / Q000139:chemically induced; D057210:Delayed Diagnosis; D004630:Emergencies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000506:poisoning*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D056784:Leukoencephalopathies / Q000139:chemically induced*; D008279:Magnetic Resonance Imaging; D015877:Miosis / Q000139:chemically induced; D011041:Poisoning / Q000175:diagnosis; D012021:Reflex, Abnormal / Q000187:drug effects; D019564:Unnecessary Procedures
chemical_list: D005283:Fentanyl