Severe 3,4-Methylenedioxymethamphetamine (MDMA)-Associated Rhabdomyolysis in Crohn's Disease: Direct Toxicity and Inflammatory Susceptibility in the Absence of Hyperthermia.
Cureus January 1, 2026 Sebastian Hernandez Mejia, Aishwarya Ashwinee, Ranwa Aldaker
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.