Severe rhabdomyolysis induced by cocaine contaminated with caffeine: a case report

Background: Global consumption of illicit substances has increased, and cocaine dependence remains an important public health problem. Currently, the use of adulterants can overlap or exacerbate the symptoms of cocaine intoxication hindering the diagnosis. This case shows how the morbidity and mortality of inhaled cocaine consumption adulterated with caffeine can increase by generating unusual severe rhabdomyolysis and rare serious complications. Case presentation: 31-year-old Hispanic male, single, construction worker, generally healthy except for the past history of inhaled cocaine hydrochloride dependence, who after three days of cocaine snorting presented profound altered state of consciousness and multiple complications,   liver damage, kidney failure and severe rhabdomyolysis (CPK=657625 U/L, troponin=3.6, potassium=6 mEq/L). After fourty-five days in the ICU, the patient stayed for two more months hospitalized for the treatment of healthcare-associated infections before being discharged without sequelae. An analysis of the powdered substance consumed by the patient confirms the presence of caffeine as cocaine adulterant. None other additional substance was detected in the sample. Discussion. This clinical case describes serious complications presented by the excessive consumption of cocaine adulterated with caffeine. Notably, most of the complications herein described were of unexpected severity and duration for an acute cocaine intoxication.  This case can suggest that in patients suffering from cocaine who have severe rhabdomyolysis, a simultaneous consumption of adulterants such as caffeine should be considered.