Severe 3,4-Methylenedioxymethamphetamine (MDMA)-Associated Rhabdomyolysis in Crohn's Disease: Direct Toxicity and Inflammatory Susceptibility in the Absence of Hyperthermia.
Sebastian Hernandez Mejia, Aishwarya Ashwinee, Ranwa Aldaker
Cureus January 1, 2026 DOI: 10.7759/cureus.101526 via PubMed
Summary
A 45-year-old man without prior health problems developed severe rhabdomyolysis (creatine kinase 160,000 U/L) and acute kidney injury requiring dialysis after taking 1.5 grams of pure MDMA, despite never having a fever. This is the first reported case of severe MDMA-associated rhabdomyolysis without hyperthermia and the third-highest creatine kinase values documented. He was later diagnosed with Crohn's disease, suggesting that underlying inflammatory bowel disease-related muscle inflammation may have made him more susceptible to muscle injury. The case indicates a non-hyperthermic mechanism of MDMA toxicity involving direct mitochondrial and oxidative damage to skeletal muscle, potentially worsened by occult Crohn's disease, and underscores that MDMA toxicity should be considered even in afebrile patients with severe rhabdomyolysis.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 45-year-old man |
| Keywords | 4-Methylenedioxymethamphetamine MDMA Acute kidney injury Chron's disease Inflammatory bowel disease Inflammatory myopathy |
| Key finding | Severe MDMA-associated rhabdomyolysis and acute kidney injury can occur without hyperthermia, possibly through direct mitochondrial and oxidative muscle injury, and may be amplified by underlying Crohn's disease. |
Abstract
Rhabdomyolysis is a recognized complication of 3,4-methylenedioxymethamphetamine (MDMA), usually driven by severe hyperthermia and agitation. We describe a previously healthy 45-year-old man who developed profound rhabdomyolysis (creatine kinase (CK) 160,000 U/L) and intrinsic acute kidney injury requiring hemodialysis after ingesting 1.5 g of "Molly" (pure MDMA), despite remaining afebrile throughout. In the literature review, the first reported case of severe MDMA-associated rhabdomyolysis without hyperthermia and the third-highest CK values was documented. He later received a new diagnosis of Crohn's disease, raising the possibility that inflammatory bowel disease-related myositis created an "immune-primed" susceptibility to muscle injury. In contrast to typical MDMA cases, there was no hyperthermia, exertion, serotonin syndrome, or significant electrolyte abnormality to explain the muscle breakdown. This case, therefore, supports an under-recognized, non-hyperthermic mechanism of MDMA toxicity involving direct mitochondrial and oxidative skeletal muscle injury, potentially amplified by occult Crohn's disease, and highlights the need to consider MDMA toxicity even in afebrile patients presenting with severe rhabdomyolysis.