Severe Ecstasy poisoning in an 8-month-old infant

We report on an 8-month-old male infant who accidentally ingested an Ecstasy tablet (3,4-methylenedioxymetamphetamine, MDMA). Here we discuss, according to the available literature, the treatment, complications, and pharmacokinetics of MDMA intoxication in a young infant. Serum MDMA level 2 hours after ingestion was with 785 ng·mL^-1 above the dose considered lethal for adults (>500 ng·mL^-1). After ingestion the patient showed life-threatening tachycardia of 210 beats min ^-1, hyperthermia of 38.9°C, seizures, and hypertension of 125/70 mmHg. Under supportive treatment (benzodiazepine, body cooling, rehydration therapy), 6 hours after admission, body temperature as well as the elevated blood pressure and heart beat had returned to normal values. Nine hours after ingestion the serum MDMA level was still 274 ng·mL^-1. The patient made a full clinical recovery and afterwards appeared to be a healthy boy. This case illustrates the need to consider the possibility of accidental Ecstasy ingestion in the differential diagnosis of a child suffering from convulsions with fever.