A 26-year-old cachectic man with chronic drug abuse presented with altered mental status, agitation, tremors, hyperthermia, diaphoresis, and dilated pupils after acute ingestion of MDMA. His condition deteriorated, requiring sedation and intensive care. Serotonin syndrome was diagnosed using Hunter criteria, and supportive care managed a brief delirium. After recovery, blood work revealed concurrent thyrotoxicosis, which may have contributed. He was treated for thyroid disease and referred for specialist follow-up.
A man with no prior psychiatric risk factors or criminal history developed a lasting psychotic episode after using ayahuasca, a plant-based psychedelic containing DMT. During the episode he seriously assaulted a relative and was admitted to a forensic psychiatric unit. Treatment with the antipsychotic aripiprazole resolved his psychotic symptoms, and recovery was sustained 18 months after admission. Previous case reports described psychosis after ayahuasca use but typically brief and in people with personal or family psychiatric history or other substance use. This case highlights that ayahuasca can trigger prolonged psychosis and risk of violence even in low-risk individuals.
Chronic heavy ketamine use over 15 years in a man in his 30s led to progressive failure of multiple organ systems, including bladder inflammation (ketamine cystitis), bile duct damage (cholangiopathy), urinary tract obstruction, heart muscle disease (cardiomyopathy), and mood disorder. The case demonstrates that long-term ketamine misuse can cause cumulative, widespread toxicity affecting many parts of the body.