Management of Suspected α-Pyrrolidinoisohexanophenone (α-PiHP)-Related Hyperthermia in a Young Adult: A Case Report

Synthetic cathinones, commonly known as "bath salts," have been increasingly implicated in severe health incidents. α-Pyrrolidinoisohexanophenone (α-PiHP) is one of the substances for which clinical data remain limited. In this article, we report a case of a 32-year-old male patient who ingested five grams of α-PiHP in a suicide attempt, resulting in hyperthermia and severe complications, including rhabdomyolysis and acute kidney injury. Despite the lack of confirmation for α-PiHP intoxication in toxicology screens, the patient's reported history was strongly suggestive. Considering a diagnostic uncertainty between serotonin syndrome and sympathomimetic toxidrome, and given the unavailability of cyproheptadine, dantrolene was administered to control the hyperthermia, resulting in a prompt and effective reduction in core body temperature. This case highlights the potential utility of dantrolene in treating hyperthermia induced by synthetic cathinones.