Severe Hyponatremic Encephalopathy Induced by Unsupervised "Therapeutic" 3,4-Methylenedioxymethamphetamine Use in a 55-Year-Old Woman: A Diagnostic Pitfall.
Cureus May 1, 2026 Pierre-Henri Woitrin, Pascale Lievens
MDMA toxicity, once stereotyped as affecting only young people in nightclubs, may now appear in older individuals using the drug for self-directed therapy, creating a diagnostic trap for emergency physicians. A 55-year-old woman developed life-threatening hyponatremic encephalopathy after taking MDMA in a private home, not a rave. Her severe hyponatremia and neurological decline were initially puzzling because her age and setting did not match the expected profile. The case underscores that representativeness bias—judging based on a stereotypical category—can cause clinicians to overlook MDMA as a cause of unexplained hyponatremia with altered mental status, regardless of patient age or social context.