Annals of Internal Medicine: Clinical Cases · Published 2026-08-01 · DOI 10.7326/aimcc.2025.1373
Anand Shah, Julie Ponn, Muhammad Hassaan Arif Maan, Anand Patel, Yonatan Greenstein
Synthetic cannabinoids (SCs) are potent cannabinoid receptor agonists with unpredictable toxicities. We describe a 40-year-old woman who presented with altered mental status after confirmed MDMB-4en-PINACA exposure. Imaging revealed left internal carotid and middle cerebral artery occlusion, a mobile aortic arch thrombus, bilateral renal infarcts, and left iliac artery involvement. Hypercoagulability evaluation did not identify an underlying thrombophilia. This case highlights the potential of SCs to precipitate widespread arterial thrombosis and underscores the importance of targeted toxicology testing and comprehensive vascular imaging.
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Shah, A., Ponn, J., Maan, M., et al. (2026). MDMB-4en-PINACA-Associated Systemic Thrombosis: A Case Report. Annals of Internal Medicine: Clinical Cases. https://doi.org/10.7326/aimcc.2025.1373