Acute 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity Leading to Fulminant Hepatic Failure and Emergency Liver Transplantation
Cureus December 20, 2025 Marcus Vinícius de Aragão Batista, Miguel Barbosa, José Casimiro et al.
A previously healthy 22-year-old man developed seizures, hyperthermia (43 °C), and cardiovascular collapse one hour after ingesting MDMA. Laboratory results showed severe metabolic acidosis, rhabdomyolysis with creatine kinase over 360,000 U/L, acute kidney injury, disseminated intravascular coagulation, and rapidly progressive hepatic necrosis with aspartate aminotransferase/alanine aminotransferase over 3000 U/L and factor V below 5%. Despite aggressive resuscitation, continuous renal replacement therapy, N-acetylcysteine, plasma exchange, and hemoadsorption, hepatic failure progressed. On day 5, urgent orthotopic liver transplantation was performed, and the patient gradually stabilized. The case illustrates that MDMA can cause catastrophic systemic toxicity and that timely liver transplantation can be lifesaving.