Surreptitious Administration of Disulfiram Along with Its Implantation Leading toDisulfiram-associated Encephalopathy: A Case Report

Abstract

Disulfiram is a US FDA–approved medication for the management of alcohol use disorder. However, compliance with disulfiram has been the Achilles’ heel of its efficacy. Implantation and surreptitious administration of disulfiram are two methods occasionally used to ensure disulfiram compliance. We present the case of a 45-year-old man who underwent disulfiram implantation. Upon consuming his first drink after this procedure, his wife administered him a hefty dose of disulfiram tablets surreptitiously. The patient subsequently developed a state of fluctuating orientation, marked impairment in attention and concentration, dyscalculia, along with memory and motor deficits. The diagnostic dilemma associated with such a presentation, along with the ethical violations and medical risks associated with implantation and surreptitious use, is discussed. Disulfiram-associated encephalopathy is a rare consequence of disulfiram use and was precipitated in this patient by the administration of disulfiram using the above methods.