title: Unusually Prolonged Presentation of Designer Drug Encephalopathy Responsive to Steroids.
abstract: The availability and use of novel psychoactive substances has risen dramatically over the last decade. The unpredictability of their toxicity constitutes a real challenge. We report a case of an adolescent who developed prolonged encephalopathy after ingesting "Hot Molly," which was found to contain the novel psychoactive substance, methylenedioxybenzylpiperazine when analyzed by high resolution mass spectrometry assay. This is the first case of human toxicity from methylenedioxybenzylpiperazine ingestion in the medical literature confirmed by body fluid analysis presenting with significant and prolonged encephalopathy. The prolonged course may be due to CYP2D6 inhibition from a combination of the methylenedioxyphenyl moiety and the patient's ultrarapid metabolizer pharmacokinetics. The response to high dose corticosteroids suggests a possible inflammatory effect that warrants further investigation.
authors.affiliation: Departments of Neurology and ralbadareen@kumc.edu albadareenrawan@yahoo.com.
authors.forename: Rawan
authors.initials: R
authors.lastname: Albadareen
authors.affiliation: Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas;
authors.forename: Stephen
authors.initials: S
authors.lastname: Thornton
authors.affiliation: Sections of Pediatric Neurology and Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri; and.
authors.forename: Arezou
authors.initials: A
authors.lastname: Heshmati
authors.affiliation: Department of Laboratory Medicine, University of California-San Francisco, San Francisco, California.
authors.forename: Roy
authors.initials: R
authors.lastname: Gerona
authors.affiliation: Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri; and Clinical Toxicology, Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lowry
mesh_terms: D000293:Adolescent; D001925:Brain Damage, Chronic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D015198:Designer Drugs / Q000506:poisoning*; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*
chemical_list: D015198:Designer Drugs; D005938:Glucocorticoids; D008775:Methylprednisolone