A middle-aged man was found unconscious in his hotel room after taking the synthetic painkiller fentanyl. Doctors wrote in the journal BMJ Case Reports that this could cause lethal leukoencephalopathy, which is damage to the brain that can't be fixed.
Leukoencephalopathy is an inflammation and harm of the brain's white matter,
which is made up of nerve cells that allow different parts of the gray matter
to talk to each other and share information.
Toxic leukoencephalopathy is a rapid or long-lasting brain condition that has
been seen in people who smoke heroin, also known as "chasing the
dragon." However, the study writers say this is the first case linked to
fentanyl.
The condition shows up in many ways, but the most noticeable ones are changes
in the brain and behavior, which can range from mild confusion to stupor, coma,
and death.
The report's writers say that the future for those harmed relies on how badly
their white matter has been damaged: Some people will get better completely,
while others will get worse over time.
In this case, the man had no history of any serious health problems. He had
been asleep in his hotel room for an unknown amount of time, where crushed
pills and a white substance were discovered on a nearby table.
When he got to the hospital, he couldn't answer questions or do what he was
told. He moved his legs in response to pain, but not his arms.
A brain scan showed damage to the cerebellum and white matter that was swollen
and inflamed. This part of the brain controls how we walk and keep our balance.
He did not test positive for seizures.
A drug test came back clean, but a different pee test showed a very high amount
of fentanyl. This led to the diagnosis of lethal leukoencephalopathy caused by
breathing in fentanyl.
After 18 days, he was still stuck in bed and needed to be fed through a tube.
He was given a number of different drugs to help with his urine leakage, kidney
damage, memory loss, pain and agitation, and what was thought to be painkiller
withdrawal.
After 26 days, he was sent to a recovery center and after another month, with
the help of private exercise and occupational therapy, he went back home.
In less than a year after going to the hospital, he was fully better and back
at work full time.
In response to the event, he calls his recovery "miraculous" and says,
"At first, it looked like I would need 24-hour care after being released,
but I focused and worked hard in therapy and was determined not to leave the
hospital only to be checked into a group facility for ongoing care."
He thanks the doctors and nurses who not only saved his life but also helped
him get back to the life he had before. "I have many regrets about what I
did to myself, my wife, and my family," he says.
The writers say, "This case illustrates the need for inclusion of fentanyl
in routine urine drug screens for earlier identification and appropriate
management."
