Accidental amphetamine ingestion in an infant: expanding the differential for seizure-like activity

Amphetamine ingestion in infants is uncommon but can mimic serious neurologic conditions such as epileptic seizures or meningitis. We report a 4-month-old boy who presented with irritability, high blood pressure, and seizure-like activity. Against a possible infectious cause, he underwent neuroimaging and empirical administration of ceftriaxone and acyclovir. An infectious cause was not discovered despite the workup. Neuroimaging, respiratory polymerase chain reaction, and laboratory studies were all unremarkable. A urine drug screen later confirmed that the infant had ingested amphetamine, which explained his symptoms. After discontinuing the empirical treatment, he was discharged on day 3 in a stable condition. This case highlights the importance of maintaining a broad differential diagnosis and using a urine drug screen as a diagnostic tool early in the workup of an infant with sympathomimetic toxidrome or seizure-like activity.