Acute 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity Leading to Fulminant Hepatic Failure and Emergency Liver Transplantation
Cureus – December 20, 2025
Source: OpenAlex
Summary
A 22-year-old man experienced severe complications after ingesting MDMA, leading to fulminant hepatic failure and multiorgan dysfunction. Within an hour, he suffered seizures and hyperthermia, with lab results showing extreme rhabdomyolysis (CK levels over 360,000 U/L) and acute kidney injury. Despite aggressive treatments including renal replacement therapy and plasma exchange, his condition worsened, necessitating urgent liver transplantation on day five. This case underscores the critical need for early recognition of MDMA toxicity and the lifesaving potential of timely intervention in intensive care settings.
Abstract
Recreational use of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") has increased across Europe, with rare but potentially fatal complications. We report a case of fulminant hepatic failure and multiorgan dysfunction following acute MDMA intoxication in a previously healthy 22-year-old man. One hour after ingestion, he developed seizures, hyperthermia (43 °C), and cardiovascular collapse. Laboratory results revealed severe metabolic acidosis, rhabdomyolysis (creatine kinase (CK) >360 000 U/L), acute kidney injury, disseminated intravascular coagulation, and rapidly progressive hepatic necrosis (aspartate aminotransferase (AST)/alanine aminotransferase (ALT) >3000 U/L, factor V <5%). Despite aggressive resuscitation, continuous renal replacement therapy, N-acetylcysteine infusion, plasma exchange, and hemoadsorption, hepatic failure progressed. On day 5, urgent orthotopic liver transplantation was performed. Postoperatively, immunosuppression and antimicrobial prophylaxis were initiated, and the patient gradually stabilised. This case highlights the potential for catastrophic systemic toxicity from MDMA, the importance of early recognition, intensive support, and the role of timely liver transplantation in ensuring survival.