A 47-year-old man nearly died after inhaling fentanyl caused his brain to swell, in the first such case involving the deadly drug.
The condition, toxic leukoencephalopathy, is usually linked to snorting heroin, and doctors said in a case report that this was the first time it was linked to illicit fentanyl.
The patient, a Seattle man, was found collapsed in his hotel room in February 2023 while on a business trip.
He was previously healthy, had no known medical history and was taking fentanyl for the first time, doctors said in the BMJ Case Reports.
Unidentified crushed pills and a white residue were found on the table in his hotel room and white powder was visible around his mouth. She also had dry vomit and little red blood on her lips.
A 47-year-old man nearly died after inhaling fentanyl caused his brain to swell, in the first such case involving the deadly drug (stock)
Toxic leukoencephalopathy is a rare condition that causes damage to the white matter of the brain, a network of nerve fibers that allows different areas of the brain to communicate with each other.
The condition causes confusion, behavioral changes, impaired body control, motor deficits, unresponsiveness, and death.
Toxic leukoencephalopathy has been reported after heroin inhalation, known as “chasing the dragon.”
This occurs when heroin is placed on a piece of aluminum foil, heated from below using a flame, and the vapor is inhaled through a straw or other tube-shaped structure.
Doctors have said that the white matter could become inflamed and injured because the toxins from heroin and fentanyl damage the myelin sheath, the insulating layer that surrounds nerves in the brain, or the capillary endothelium, which is the barrier between blood and brain.
About 17 percent of patients with this condition who have inhaled heroin will die. There is no definitive treatment for the condition, but it may include high doses of vitamin C and E.
White matter inflammation is thought to occur as part of the brain’s reaction to heroin exposure.
Emergency medical services gave the man naloxone, a medication that quickly reverses an opioid overdose, but it didn’t work.
He was taken to the hospital where he was unresponsive.
A brain MRI revealed white matter inflammation, swelling and damage to the cerebellum, the part of the brain responsible for walking and balance.
A urine analysis showed a very high level of fentanyl, leading doctors to diagnose the man with toxic leukoencephalopathy caused by fentanyl inhalation.
While this is the first documented case, Dr. Christopher Eden, a second-year internal medicine resident at OHSU School of Medicine who was part of the patient’s treatment team, said it’s likely that other cases simply weren’t recognized due in part to the fact that relatively little is known about the physiology of the syndrome.
The case is a warning about the dangers of fentanyl, which is cheap, readily available and 50 times more potent than heroin.
“Opioid use, especially fentanyl, has become highly stigmatized,” Dr. Eden said.
And he added: ‘This is the case of a middle-class man, in his 40s, with children, who used fentanyl for the first time. It shows that fentanyl can affect everyone in our society.’
The patient gradually recovered in the hospital over 26 days, followed by a brief stay in a nursing facility to help him regain speech and function.
He’s now back home with his family in the Seattle area and back to work, but he still doesn’t remember the episode.
Commenting on the incident, he describes his recovery as “miraculous” and said: “At first it looked like I would need 24-hour care after being discharged, but I focused and worked hard in my therapy session and was determined not to leave.” “. “The hospital only to be admitted to a group facility for continued care.”
He expressed his gratitude to all the health professionals who not only saved his life but allowed him to return to the life he had before, adding: “I often regret what I did to myself, to my wife and my family.”
