A case of cardiotoxicity following intramuscular injection of tropicamide and phenylephrine ophthalmic solution in a drug-addicted young woman

We report the case of a 40-year-old woman with a history of an opioid use disorder who presented to our emergency department complaining of palpitations, chest pain, and headache after the intramuscular injection of an ophthalmic solution containing tropicamide and phenylephrine (Visumidriatic Phenylephrine® 100 mg/mL + 5 mg/mL, Visufarma S.p.A., Italy) a few hours earlier for a voluntary purpose. She developed cardiac toxicity with hypertension, tachycardia, and high levels of high-sensitivity cardiac troponin I, which required continuous cardiac monitoring for 48 hours with complete resolution of the cardiac damage without complications. Based on the current literature, this is the first reported case of cardiotoxicity induced by an ophthalmic solution of tropicamide and phenylephrine used intramuscularly for voluntary purposes.