A Rare Case of Heroin-induced Leukoencephalopathy after Intravenous Abuse in a Person Living with Human Immunodeficiency Virus

Abstract Opioid intoxication can lead to varied neurologic complications including delirium, sedation, cognitive impairment, hallucinations, seizures, and myoclonus. One of the rare neurological impairments is toxin-induced leukoencephalopathy. Heroin-induced leukoencephalopathy (HLE) is a rare but critical neurological disorder seen in heroin users which carries high morbidity and mortality. It most commonly occurs with inhalational use of heroin also known as chasing the dragon syndrome. We report a 26-year-old person living with human immunodeficiency virus who presented with altered sensorium after intravenous heroin use. On examination, the patient was found to have dysautonomia with tachycardia and flushing of face and generalized rigidity of limbs with high-grade fever. Laboratory results were consistent with kidney and liver dysfunction with underlying rhabdomyolysis. An extensive Infectious workup turned out to be negative. Magnetic resonance imaging brain changes were consistent with toxin-induced leukoencephalopathy. The patient was managed conservatively with antioxidants and supportive care. This case highlights the clinical and radiological characteristics seen in HLE.