A Case of Fentanyl Intoxication and Delayed Hypoxic Leukoencephalopathy Caused by Incidental Use of Fentanyl Patch in a Healthy Elderly Man

Abstract

Background: Fentanyl intoxication has been reported occasionally since the Fentanyl patch became available. Delayed hypoxic leukoencephalopathy is recognized as a complication of hypoxic events. However, its neuropsychiatric symptoms can be delayed. Case Report: An 85-year-old male presented with mental deterioration after attaching a Fentanyl patch. A hypoxic condition was detected. Neurological examination revealed semi-coma, pupil myosis, sluggish light reflex, and no response to deep pain. He recovered gradually but showed delayed neuropsychiatric symptoms 40 days after the hypoxic event. These symptoms were improved steadily. He could talk and walk after 3 months. Conclusion: The case of acute fentanyl intoxication and delayed hypoxic leukoencephalopathy reported here is caused by incidental use of a Fentanyl patch in a healthy elderly man. When patients are admitted with mental deterioration, respiratory depression, and pupil miosis, physicians should consider opioids intoxication including Fentanyl patch. In addition, it is important to understand the clinical course of leukoencephalopathy as a delayed complication after recovery from acute fentanyl intoxication.

Keywords

• Fentanyl
• Leukoencephalopathy
• Intoxication
• Hypoxia