Teaching Case

Unexplained jaundice. Physical examination revealed hepatomegaly. Laboratory tests showed abnormal liver enzymes and signs of acute liver failure.

A 17-year-old man was admitted with unexplained jaundice. Physical examination revealed hepatomegaly. Laboratory tests showed abnormal liver enzymes and signs of acute liver failure. An ultrasonography and CT scan (fig. 1 and fig. 2 A) of the abdomen were carried out. After repeated anamnesis, the patient admitted to be a regular XTC-user. A liver biopsy confirmed toxic hepatitis. These findings as well as the laboratory and the imaging data were diagnostic for acute chemically-induced liver failure.

Ecstasy (3,4-Methylene-dioxymethamphetamine) is a popular recreational drug, which has been developed from the basic structure of amphetamine. The drug is related to a certain youth culture. The desired effect of ecstasy (enhanced openness, awareness and empathy) has led to abuse which, in connection with certain cultural behaviour (prolonged activity and/or alcohol abuse) can cause severe complications. Among those, undesirable psychiatric effects (depression, psychoses) as well as somatic effects such as fulminant hyperthermia, convulsions, disseminated intravascular coagulation, acute renal failure, rhabdomyolysis and toxic hepatitis have been described. Radiological findings are non-specific and include hepatomegaly and periportal edema. In young patients with jaundice and liver dysfunction XTC-induced toxic liver failure should be considered in the differential diagnosis.