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Diffuse cystic leucoencephalopathy after buprenorphine injection
Buprenorphine has been prescribed for opioid detoxification and subsequent maintenance therapy with favourable outcomes. Its high affinity for the mu receptor, higher analgesic potency than morphine, antagonistic effects at higher doses as a partial agonist, lower incidence of physical dependence, and mild withdrawal symptoms confer qualities that make it advantageous for the treatment of opioid dependence.1 Buprenorphine, marketed under the trade name Subutex, may be administered sublingually, subcutaneously, or intravenously. We describe a severe neurological effect of intravenous buprenorphine exposure that resulted in diffuse cystic leucoencephalopathy.
Case report
An 18 year old man was found unconscious in his bedroom by his girlfriend. He had no past history, and no family history of neurological or metabolic diseases. He was brought to the emergency room febrile, comatose and in severe respiratory failure (pH 7.399, pO2 84 mmHg, pCO2 42 mmHg, bicarbonate 24.9 mmol/l, on 100% non-rebreathing mask). He was intubated and treated presumptively for pneumonia with intravenous imipenam and azithromycin. He did not require inotropic support. Physical examination revealed a drowsy and lethargic man, who had bilateral basal crepitations in the lungs. Apart from midrange pupils that were sluggishly reactive to light, the neurological examination was unremarkable. There was no evidence of external bruises, injuries or obvious needle track marks …
Footnotes
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Competing interests: none declared