1526 - A Rare Case of Heroin-Induced Leukoencephalopathy

Case Diagnosis: Heroin-Induced Leukoencephalopathy

Case Description: 29-year-old male with past medical history of anxiety, insomnia and substance abuse presented to the hospital six days after attempting a self detoxification. Prior to arrival, patient experienced two days of diaphoresis, nausea, vomiting and fatigue after heroin inhalation. Suboxone strips were used in an attempt to calm withdrawal symptoms, and after two days all symptoms subsided. The patient began to exhibit lethargy, delayed speech, abnormal gait, generalized weakness and a decreased appetite. Patient was subsequently brought to the hospital. Upon arrival narcan was not administered as the patient was not exhibiting any features suggestive of an overdose. Physical examination demonstrated delayed verbal responses, decreased command following, and lethargy. CBC revealed an elevated white blood cell count of 12.9 one day after admission. MRI revealed nonspecific, extensive T2 FLAIR hyperintensity throughout the entire cerebral white matter extending into the internal capsules, thalamic and cerebellar hemispheres in a symmetrical distribution.

Discussions: Heroin-induced leukoencephalopathy (HLE) is a very rare yet severe neurological disease resulting from heroin use. HLE is more often associated with heroin inhalation, as seen in this case. Although diagnosis of HLE is clinical, imaging and/or brain biopsy may be used to confirm the diagnosis. Prior research has shown that patients can see benefits when treated with antioxidant therapy and physical rehabilitation. HLE’s severity ranges from mild to severe. Mild situations often affect cerebellar function, presenting as ataxia. As severity increases there is potential for musculoskeletal dysfunction such as hyperreflexia, weakness, and spasticity. Symptoms may even present as Parkinsonian in extreme cases.

Conclusions: This case highlights the imperative diagnosis of heroin-induced leukoencephalopathy as a rare yet significant consequence of heroin abuse, emphasizing the need for clinical awareness and early recognition to attenuate its potentially devastating impact on affected patients.