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

Authors

• M Nour Chabalout, Internal Medicine, Tower Health Medical Group, Phoenixville, USAFollow
• Mohamed Darwish, Internal Medicine, Tower Health Medical Group, Phoenixville, USAFollow
• Imad Alabdul Razzak, Internal Medicine, Tower Health Medical Group, Phoenixville, USAFollow
• Mohanad Alkhalaila, Internal Medicine, Tower Health Medical Group, Phoenixville, USAFollow

Document Type

Article

Publication Date

2-2026

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.

Publication Title

Cureus

Volume

18

Issue

2

First Page

103350

Last Page

103350

Recommended Citation

Chabalout, M., Darwish, M., Alabdul Razzak, I., & Alkhalaila, M. (2026). Not a Disease of the Past: A Case Report of Heroin-Induced Toxic Leukoencephalopathy Causing Progressive Neurologic Decline.. Cureus, 18 (2), 103350-103350. https://doi.org/https://doi.org/10.7759/cureus.103350