Afebrile Convulsive Status Epilepticus Associated with Suspected Accidental 3,4-Methylenedioxymethamphetamine (MDMA) Intoxication in A 20-Month-Old Boy: A Case Report

Abstract

Aims: To report an unusual presentation of suspected accidental 3,4-methylenedioxymethamphetamine (MDMA) intoxication as afebrile convulsive status epilepticus (CSE) in a toddler and to emphasise the importance of considering toxicological causes when conventional investigations are unrevealing. Presentation of Case: A previously healthy 20-month-old boy presented with generalised afebrile CSE lasting approximately 30 minutes. Seizures were terminated with intravenous midazolam. Notably, the child had none of the classical sympathomimetic manifestations commonly associated with MDMA intoxication, including hyperthermia, tachycardia, hypertension, mydriasis, or agitation. Routine laboratory investigations, brain computed tomography, electroencephalography, and magnetic resonance imaging were unremarkable. Urine toxicological screening performed at the Moroccan Poison Control and Pharmacovigilance Center using a qualitative immunochromatographic assay was positive exclusively for MDMA. The history subsequently confirmed accidental ingestion of the contents of a bottle found in a public garden. The child received supportive management, remained seizure-free, and was discharged after three days with complete neurological recovery. Conclusion: This case highlights the atypical possibility of isolated afebrile CSE as a presenting manifestation of suspected accidental MDMA intoxication in a toddler, even in the complete absence of a sympathomimetic toxidrome. In cases of unexplained afebrile seizures, early toxicological screening may provide an important diagnostic clue. Because qualitative immunochromatographic assays are screening tests, positive results should be interpreted cautiously and, whenever available, confirmed using specific chromatographic methods.