Fatal Multiorgan Dysfunction Syndrome Secondary to Cocaine Toxicity.

Cocaine toxicity is a well-recognized cause of multiorgan dysfunction due to its potent sympathomimetic, vasoconstrictive, and prothrombotic effects. Severe cases can result in cardiogenic shock, rhabdomyolysis, acute kidney injury (AKI), and acute hepatic failure. We describe a case of a 50-year-old female with a history of substance use disorder who presented with cocaine intoxication, unresponsive to naloxone, and required intubation. She developed distributive shock requiring triple vasopressor support and suffered recurrent cardiac arrests with temporary return of circulation. Laboratory findings showed rhabdomyolysis (creatine kinase (CK) 29,074), AKI (creatinine 5.8 mg/dL), elevated troponins (9,978 ng/L), severe metabolic acidosis, and hepatic injury. Despite continuous renal replacement therapy (CRRT), empiric broad-spectrum antibiotics, and maximal supportive care, she remained comatose with progressive multiorgan failure and expired on hospital day three. This report underscores the severe systemic and often fatal complications of cocaine toxicity.