Life-threatening neurotoxicity following off-label ivermectin use in metastatic breast cancer: a case report.

BACKGROUND

The United States Food and Drug Administration (FDA) has explicitly discouraged the use of ivermectin for the treatment of cancer outside of clinical trials. Nevertheless, patient self-administration persists, frequently influenced by information encountered online. Cases of ivermectin neurotoxicity in the oncology setting remain underreported despite growing off-label use driven by online misinformation. We present a case of severe neurotoxicity following unintentional high-dose self-administration of ivermectin as an off-label attempt to treat breast cancer.

CASE PRESENTATION: A 73-year-old female with metastatic breast cancer self-administered high doses of ivermectin based on information obtained online. She subsequently developed acute altered mental status, generalized seizures, and respiratory failure. Her clinical course was consistent with severe ivermectin-induced neurotoxicity, necessitating supportive management including intubation, mechanical ventilation, intravenous fluids, and anticonvulsant therapy. The patient demonstrated full neurological recovery to baseline within 48 hours.

CONCLUSION

This case highlights the potential for life-threatening neurotoxicity associated with high-dose ivermectin use. Increasing online health misinformation has led to the self-administration of unproven therapies; therefore, clinicians should counsel patients on the risks of non-evidence-based treatments. A thorough exposure history is essential to identify uncommon causes and maintain vigilance for severe adverse reactions.