History and clinical findings: A 51-year-old man without relevant previous
illness developed vomiting and diarrhoea, later also tingling and hypaesthe
sias in the limbs, as well as optical hallucinations that had occurred afte
r a mid-day meal and drinking red wine. Neurological examination revealed v
ariable pupillary reactions with anisocoria that would change from one side
to the other. There was no paresis, muscle reflexes were brisk, more so on
the right. Babinski reflex was positive on the right, there was an unsusta
ined clonus of the right foot and the coordination tests were normal. Dista
l symmetrical hypaesthesias and paraesthesias were present in all limbs. An
exogenous psychosis with restlessness and optical hallucinations was obser
ved.
Investigations: Routine blood count revealed leukocytosis. Serum concentrat
ions of cGt and GPT were raised. Cerebral computed tomography and cerebrosp
inal fluid as well as microbiological tests of the mid-day meal were normal
.
Diagnosis, treatment and course: As the cause of the symptoms was initially
unclear the patient was admitted to hospital and monitored without any spe
cific treatment. Within one night all symptoms had disappeared and he was d
ischarged the next morning without any complaints. Later the red wine which
he had drunk was examined toxicologically and found to contain the >>desig
ner drug<< DOB (2,5-dimethoxy-4-bromamphetamine).
Conclusion: Accidental poisoning with DOB is probably a rare event which ca
n hardly be included in routine differential diagnosis. If an acute cerebra
l organic syndrome has been excluded, only toxicological investigation can
help in establishing the diagnosis in such cases.