Deep venous thrombosis of the axillary and humeral veins following Ecstasy use: A case report

Background: 3,4-methylenedioxymethamphetamine (MDMA), or "Ecstasy," is a semi-synthetic stimulant and hallucinogen widely used recreationally. While known for producing euphoria, it is associated with severe medical complications including serotonin syndrome, rhabdomyolysis, and multi-organ failure. Although MDMA is known to cause various vascular and muscular lesions, deep venous thrombosis (DVT) in the upper limbs remains a rare but serious consequence.
Case Presentation: A 20-year-old male was admitted to the emergency department after consuming ecstasy, Zepam, and alcohol. He presented with classic signs of serotonin syndrome (disturbed consciousness, hyperhidrosis, tremors, and fever) alongside intense pain and significant edema in the left upper limb.
Diagnostics: Venous echodoppler confirmed thrombosis of the left humeral and axillary veins. Laboratory tests revealed severe rhabdomyolysis (CPK: 23,304) and hepatic cytolysis.
Management: Treatment included anticoagulant therapy (low-molecular-weight heparin transitioned to Rivaroxaban), hydration, and analgesics.
Complications: On day 7, the patient developed compartment syndrome due to worsening edema. While the edema eventually regressed by day 9, the patient suffered persistent sensitivomotor deficits across the median, ulnar, radial, and musculocutaneous nerves.
Discussion: The relationship between MDMA use and thrombosis may be linked to the inflammatory response and extensive muscle damage seen in rhabdomyolysis, similar to the mechanisms observed in inflammatory myopathies. While other sites of MDMA-induced thrombosis (renal and aortic) have been documented, upper limb DVT is less common.
Conclusion: MDMA use can lead to life-altering, multi-visceral damage. Despite multidisciplinary management, the prognosis for such cases can be poor due to lasting nerve damage and muscle atrophy resulting from vascular and compartment complications.