Bilateral acute necrosis of the globi pallidi and rhabdomyolysis due to combined methadone and benzodiazepine toxicity.
Methadone continues to be a widely used maintenance therapy for opiate dependence. However, methadone-related deaths have been reported frequently for over 4 decades now. Anoxic brain injury with pulmonary edema secondary to respiratory depression is the recognized mechanism of methadone death, although pathological intracranial findings are rarely described in methadone deaths. A selective area of brain injury has never been reported with methadone use. We present a case of a 23-year-old man who had acute necrosis of the bilateral globi pallidi in the brain and systemic rhabdomyolysis after ingesting methadone and nasally insufflating alprazolam. We also present a review of the literature on deaths following opioid use and associated brain injury.
Department of Pathology and Laboratory Medicine and Waisman Center, University of Wisconsin, Madison, WI 53792, USA. RCorliss@uwhealth.org
Robert F
RF
Corliss
Rakesh
R
Mandal
Benjamin J
BJ
Soriano
D000281:Administration, Intranasal; D000328:Adult; D000525:Alprazolam / Q000008:administration & dosage / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D049429:Forensic Pathology; D053593:Forensic Toxicology; D015600:Glasgow Coma Scale; D005917:Globus Pallidus / Q000473:pathology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D020300:Intracranial Hemorrhages / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D009336:Necrosis; D009474:Neurons / Q000473:pathology; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000473:pathology; D019966:Substance-Related Disorders / Q000150:complications
D006993:Hypnotics and Sedatives; D009294:Narcotics; D008691:Methadone; D000525:Alprazolam