Abstract
A 17-year-old male presented from an outside facility in acute respiratory failure and profound hypotension. He was found to have classic MRI brain findings of opiate-induced leukoencephalopathy which was corroborated with urine drug screen and history. This entity has been described in the adults but is not as well recognized in the pediatric population. As the opiate epidemic continues to evolve, this case brings heightened awareness of this disorder to pediatric radiologists.