Refractory Status Epilepticus, Serotonin Syndrome, and Fulminant Multiorgan Failure Following Synthetic Cannabinoid Vaping: A Case Report

Synthetic cannabinoids (SCs) are increasingly prevalent novel psychoactive substances associated with severe, unpredictable and potentially life-threatening toxicity. Although serotonin syndrome following SC exposure has rarely been reported, acute serotonin syndrome diagnosed during the acute phase of SC intoxication has not previously been described. A previously healthy 17-year-old male presented with refractory status epilepticus shortly after inhaling a SC-containing vape. Following withdrawal of sedation, the patient fulfilled the Hunter Serotonin Toxicity Criteria, supporting the diagnosis of serotonin syndrome. The clinical course was complicated by fulminant multiorgan toxicity, including cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), acute kidney injury requiring continuous renal replacement therapy, severe rhabdomyolysis, persistent hypoglycemia, and ischemic stroke. Routine urine toxicology screening was negative. Following prolonged supportive treatment, the patient made a complete neurological and functional recovery. This case highlights that SC intoxication may present with refractory status epilepticus, serotonin syndrome, and fulminant multiorgan failure despite negative routine toxicology screening. Early clinical recognition, close monitoring, and prompt supportive management are essential, as no specific antidote is currently available.