Cocaine-Induced Toxic Leukoencephalopathy, Serotonin Syndrome, and Central Diabetes Insipidus Following Cocaine Overdose: A Case Report of a Fatal Outcome

Cocaine use is associated with a broad spectrum of neurological and systemic complications. Toxic leukoencephalopathy is a rare but severe manifestation characterized by diffuse white matter injury. Serotonin syndrome is a toxidrome resulting from excessive serotonergic activity. Central diabetes insipidus has rarely been described in association with toxic leukoencephalopathy and may indicate extensive hypothalamic or neuroendocrine injury. We report a fatal case of a 44-year-old man presenting with toxic leukoencephalopathy, serotonin syndrome, and central diabetes insipidus following a massive cocaine overdose. Despite aggressive supportive management in the ICU, the patient developed progressive neurological deterioration and myonecrosis of his right upper arm, complicated by a radial artery pseudoaneurysm, in addition to his toxic leukoencephalopathy, serotonin syndrome, and central diabetes insipidus. To the best of our knowledge, this is the first reported case describing the coexistence of toxic leukoencephalopathy, serotonin syndrome, central diabetes insipidus, and myonecrosis following a single massive cocaine overdose.