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In recent years, ecstasy has become a very popular recreational drug. To date, very little data is available regarding its toxic side effects. Specifically, reports relating ecstasy use to the clinical diagnosis of leukoencephalopathy are quite rare. In this report, we present an interesting case of a 33-year-old female with a recent history of ecstasy abuse who presented with delirium and cognitive impairment. In addition, we review published case reports that explore the connection between MDMA and leukoencephalopathy