Exploring Underrated Cardiotoxicity and Neurovascular Implications in a 13-Month-Old Infant Following Accidental MDMA Ingestion: A Case Report and 3-Month Follow-Up

Abstract

Background: MDMA (3,4-methylenedioxymethamphetamine) intoxication in children is rare but potentially life-threatening. While neurotoxicity is better documented, cardiotoxicity in infants remains underreported. Case: Seizures in infants can have various causes, including febrile episodes, metabolic disturbances, and toxic exposures. A 13-month-old male infant presented with generalized tonic-clonic seizures and altered consciousness following confirmed accidental ingestion of MDMA. On admission, he displayed persistent sinus tachycardia (170 bpm), bilateral mydriasis, and unresponsiveness. Laboratory workup showed elevated troponin (308 ng/L), increased CPK, and normal renal function. Brain CT revealed left-sided cortico-subcortical atrophy with hypodensities. Echocardiography demonstrated preserved systolic function (EF 65%). Toxicological screening confirmed MDMA exposure. Intensive care support, including sedation, intubation, and cardiac monitoring, led to full recovery. Workup Enhancement: In addition to routine investigations, we conducted a 12-lead ECG, cardiac biomarkers (NT-proBNP, lactate), and echocardiographic strain analysis. An EEG was performed post-stabilization. Follow-up echocardiography at 3 months confirmed preserved systolic and diastolic function. Neurodevelopmental evaluation at 3 months was normal. Discussion: MDMA causes sympathetic hyperactivity via serotonin and catecholamine release, inducing cardiovascular strain. In infants, enzymatic immaturity and low body mass exacerbate toxic effects. Troponin elevation in this context likely reflects catecholaminergic myocardial stress rather than infarction. This case highlights the value of extended cardiologic workup, including strain imaging and longitudinal follow-up. Conclusion: MDMA intoxication in infants may lead to significant though reversible cardiac injury. Early recognition, intensive management, and comprehensive cardiac assessment are essential. This case supports the integration of strain echocardiography into pediatric toxicology protocols.