Cocaine poisoning is a well-known cause of systemic toxicity, primarily mediated through intense sympathetic stimulation, vasoconstriction and direct cellular injury. Although rhabdomyolysis and acute kidney injury are recognized complications, severe persistent multiorgan failure and acute pancreatitis remain rare.

We report the case of a 29-year old man with a history of chronic cocaine use who was admitted after loss of consciousness following heavy cocaine consumption. He developed severe rhabdomyolysis with creatine kinase levels exceeding 10,000 IU/L, acute kidney injury requiring prolonged hemodialysis, marked hepatic cytolysis, and grade E acute pancreatitis confirmed by computed tomography. Despite aggressive supportive management, renal failure and rhabdomyolysis persisted for several weeks, necessitating repeated dialysis sessions. No alternative etiology was identified.

Cocaine toxicity can result in severe systemic complications through intense vasoconstriction, prothrombotic effects, and direct cellular toxicity. While cardiovascular and neurological complications are well described, persistent multiorgan failure and severe acute pancreatitis remain rare and underrecognized manifestations. This case shows that cocaine overdose has the potential to cause prolonged and persistent life-threatening organ dysfunction, possibly exacerbated by chronic exposure and poly substance abuse. This kind of presentation is often challenging to manage and leads to prolonged hospital stay. Early recognition of uncommon complications and adapted supportive management are necessary to improve outcomes.