A 22-year-old man was hospitalized after stating he would ‘commit suicide in a non-detectable way’. He was admitted with a severe necrotizing pancreatitis and acute kidney injury, evolving to multiple organ failure. His condition rapidly deteriorated, and he died 11 days after hospital admission. Postmortem histopathology confirmed fulminant necrotizing pancreatitis, acute tubular necrosis, cerebral edema, pericentral/midzonal hepatocellular necrosis and acute respiratory distress syndrome. Metabolites of 4F-MDMB-BINACA, a synthetic cannabinoid, were detected in urine and serum collected at hospital admission. The same drug was found in a vapor fluid found in the man’s apartment. As cannabis use has been etiologically linked to acute pancreatitis, we hypothesize that the more afferent and potent 4F-MDMB-BINACA could induce acute pancreatitis via stimulation of cannabinoid (CB)1-receptors. Alternatively, terminal fluorination could have induced a dose-dependent toxic effect on a wide range of cellular processes, leading to cell dysfunction and death. This is the first clinicopathological description of a lethal intoxication with 4F-MDMB-BINACA, following extensive vaping. Toxic effects could either relate to CB-receptor binding or to direct fluoride toxicity.

一名 22 岁的男子在说他会“以一种无法察觉的方式自杀”后住院。他因严重坏死性胰腺炎和急性肾损伤入院，并发展为多器官衰竭。他的病情迅速恶化，入院11天后死亡。死后组织病理学证实暴发性坏死性胰腺炎、急性肾小管坏死、脑水肿、中央/中带肝细胞坏死和急性呼吸窘迫综合征。在入院时收集的尿液和血清中检测到 4F-MDMB-BINACA（一种合成大麻素）的代谢物。在该男子公寓中发现的蒸气流体中也发现了相同的药物。由于使用大麻在病因上与急性胰腺炎有关，我们假设更具传入性和效力的 4F-MDMB-BINACA 可通过刺激大麻素 (CB)1 受体诱发急性胰腺炎。或者，末端氟化可能对广泛的细胞过程产生剂量依赖性的毒性作用，导致细胞功能障碍和死亡。这是对 4F-MDMB-BINACA 致死性中毒的第一个临床病理学描述，在广泛使用电子烟后。毒性作用可能与 CB 受体结合或直接氟化物毒性有关。