Asian Journal of Pediatric Research

Afebrile Convulsive Status Epilepticus Associated with Suspected Accidental 3,4-Methylenedioxymethamphetamine (MDMA) Intoxication in A 20-Month-Old Boy: A Case Report

Soukaina Bendouz, Hind Lachraf, Hanane Laji, Imane Zineb, Assmaa Alaoui Mdaghri — Thu, 08 Oct 2026 00:00:00 +0000

Aims: To report an unusual presentation of suspected accidental 3,4-methylenedioxymethamphetamine (MDMA) intoxication as afebrile convulsive status epilepticus (CSE) in a toddler and to emphasise the importance of considering toxicological causes when conventional investigations are unrevealing.

Presentation of Case: A previously healthy 20-month-old boy presented with generalised afebrile CSE lasting approximately 30 minutes. Seizures were terminated with intravenous midazolam. Notably, the child had none of the classical sympathomimetic manifestations commonly associated with MDMA intoxication, including hyperthermia, tachycardia, hypertension, mydriasis, or agitation. Routine laboratory investigations, brain computed tomography, electroencephalography, and magnetic resonance imaging were unremarkable. Urine toxicological screening performed at the Moroccan Poison Control and Pharmacovigilance Center using a qualitative immunochromatographic assay was positive exclusively for MDMA. The history subsequently confirmed accidental ingestion of the contents of a bottle found in a public garden. The child received supportive management, remained seizure-free, and was discharged after three days with complete neurological recovery.

Conclusion: This case highlights the atypical possibility of isolated afebrile CSE as a presenting manifestation of suspected accidental MDMA intoxication in a toddler, even in the complete absence of a sympathomimetic toxidrome. In cases of unexplained afebrile seizures, early toxicological screening may provide an important diagnostic clue. Because qualitative immunochromatographic assays are screening tests, positive results should be interpreted cautiously and, whenever available, confirmed using specific chromatographic methods.

Kasabach-Merritt Phenomenon in a Neonate with a Rapidly Enlarging Vascular Tumor of the Foot and Hypercalcemia: A Case Report

S. Bendouz, M. Bahous, S. Saghir, A. Ayad, M. Sellouti, R. Abilkacem — Mon, 12 Oct 2026 00:00:00 +0000

Kasabach-Merritt phenomenon (KMP) is a potentially life-threatening consumptive coagulopathy characterised by severe thrombocytopenia and coagulation abnormalities associated with aggressive vascular tumours, particularly kaposiform hemangioendothelioma (KHE) and tufted angioma.

We report the case of a 10-day-old term male neonate who presented with a rapidly enlarging vascular mass of the right foot. The lesion had been present since birth and had rapidly increased in size, reaching 7 cm in diameter, with a violaceous nodular surface, multiple telangiectasias, focal ulceration, and a palpable thrill. Laboratory investigations revealed profound thrombocytopenia (platelet count ~4,000/mm³), elevated D-dimer levels, hypofibrinogenemia, prolonged prothrombin time, and prolonged activated partial thromboplastin time, consistent with consumptive coagulopathy.

Despite high-dose intravenous methylprednisolone, the coagulation abnormalities initially improved, but the vascular mass continued to enlarge, reaching 10 cm. Doppler ultrasonography demonstrated marked arterial and venous proliferation with peripheral arteriovenous microfistulas, while magnetic resonance imaging showed extension into the leg and deep tissues, reaching the underlying bone without bone lysis. The clinical course was additionally complicated by hypercalcaemia associated with suppressed parathyroid hormone and increased urinary calcium excretion.

Because of progressive tumour enlargement despite corticosteroid therapy, vincristine was introduced at 0.05 mg/kg intravenously once weekly, resulting in rapid platelet recovery and marked regression of the vascular mass. This case highlights the severity of KMP in the neonatal period and the importance of early recognition, multidisciplinary management, and timely escalation of therapy in patients with progressive vascular tumours.