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Not a Disease of the Past: A Case Report of Heroin-Induced Toxic Leukoencephalopathy Causing Progressive Neurologic Decline

Year: 2026

Type: article

Abstract: Toxic leukoencephalopathy is a rare neurological complication associated with various toxins, including inhaled heroin ("chasing the dragon"). We report a case of a 36-year-old female with a history of heroin dependence, in remission for seven years until a recent relapse, who presented with progressive deterioration in speech clarity, swallowing difficulty, and imbalance. Neuroimaging revealed diffuse leukoencephalopathy involving the cerebellar white matter and internal capsules, suggestive of heroin induced leukoencephalopathy. Laboratory evaluation was unremarkable, and infectious, autoimmune, and metabolic causes were considered less likely. This case highlights the importance of recognizing heroin-induced toxic leukoencephalopathy as a cause of subacute progressive neurological decline in patients with recent heroin use, even in the absence of intravenous administration.

Source: Cureus

DOI: 10.7759/cureus.103350

Authors: M.Nour Chabalout, Mohamed Darwish, Imad Alabdul Razzak, Mohanad Alkhalaila

Institution: Phoenixville Hospital

Language: English

Topic: Neurological Complications and Syndromes

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7128498724