In a case report published online today (April 29, 2024) in the journal BMJ Case Reports, clinicians present a surprising and unprecedented diagnosis: toxic leukoencephalopathy caused by inhaled fentanyl. On February 25, 2023, the 47-year-old patient was brought in by ambulance from the Emergency Department at Oregon Health & Science University. He was found unconscious in the hotel room where he had stayed during a business trip. Clinicians begin rescue treatment while looking for the cause.
In other words, inhaling fentanyl causes large swathes of white matter in the patient's brain to become inflamed, to the point that he loses consciousness, potentially irreversibly loses brain function, and possibly even dies.
Medical experts have previously documented cases due to heroin inhalation, but this OHSU patient is believed to be the first case due to inhalation of illicit fentanyl. The study's lead authors say it should serve as a warning about the dangers posed by this cheap, readily available substance, which is 50 times stronger than heroin.
"Opioid use, especially fentanyl, has become very grim, and this is the first case of fentanyl use by a middle-class man in his 40s with children," said lead author Chris Eden, MD. This shows that fentanyl can affect everyone in our society." He is now a second-year resident in the Department of Internal Medicine at the OHSU School of Medicine and a member of the Patient Treatment Team.
While this is the first recorded case, it's likely that other cases just go undetected, in part because little is known about the physiology of the syndrome, Eden said. In addition, he said that hospitals have not traditionally included fentanyl in standard urinalysis drug screenings.
At the same time, fatal and non-fatal overdoses caused by fentanyl and other opioids are common. "We are very aware of the typical side effects of opioids: respiratory depression, loss of consciousness, disorientation," Eden noted. But we don't usually think that it can cause potentially irreversible brain damage and affect the brain, as happened in this case. "
Magnetic resonance imaging shows inflammation in the brain. However, persistent loss of consciousness, memory, and function can be caused by a variety of causes, such as stroke, carbon monoxide exposure, or metabolic disease. Eventually, a non-standard drug test revealed the presence of fentanyl in his body.
Fortunately, the patient slowly recovered after 26 days in the hospital and was admitted to a skilled nursing facility to help him regain his speech and function. Now, he has returned to his home in the Seattle area to reunite with his family and get back to work. To this day, he doesn't remember it at all.
With the support of numerous clinicians at the Oregon Academic Health Center and one of the largest hospitals, a patient-centered approach to integrated care has been a success.
"This case involved internal medicine, neurology, neuroradiology and palliative care doctors, in addition to nurses, social workers, discharge planners, physical therapists, dietitians and pharmacists," Eden said. I am proud that these multidisciplinary teams at OHSU work together to care for complex patients from a medical and social perspective. "
The article, published today in BMJ Case Reports, also includes perspectives from patients.
"I often regret what I have done to myself, my wife and my family," he said. I am grateful to all the doctors, nurses, and first responders who saved my life, and to the therapists for making me a normal member of society again. "
编译来源：ScitechDaily