In the early 2000s, there was an outbreak of a Parkinsonian syndrome in 23 Latvian IV methcathinone users. MRI brain imaging demonstrated increased bilateral T-1 signal intensity in the globus pallidus. What toxin was found to be responsible?
Potassium permanganate was used in the process of oxidizing ephedrine to form the methcathinone. Users were intravenously injecting methcathinone that was contaminated with residual inorganic manganese.
Stepens A, Logina I, Liguts V, Aldins P, Eksteina I, Platkājis A, Mārtinsone I, Tērauds E, Rozentāle B, Donaghy M. A Parkinsonian syndrome in methcathinone users and the role of manganese. N Engl J Med. 2008 Mar 6;358(10):1009-17. doi: 10.1056/NEJMoa072488. PMID: 18322282.
Submitted by: Emily Kershner, MD on behalf of The Medical Toxicology Fellowship, Virginia Commonwealth University