A new psychoactive substance (NPS) that is a member of the cathinone class is 4-methylpentedrone (4-MPD).Along with cocaine, sildenafil, bromazepam, and nevirapine, we report an original case of death that was primarily caused by 4-MPD. Both the autopsy results and the investigation data pointed to fatal intoxication in a chemsex setting (drug use during sex). 4-MPD concentrations were measured using gas chromatography (GC) in conjunction with tandem mass spectrometry in peripheral blood (1285 ng/mL), cardiac blood (1128 ng/mL), urine (>10,000 ng/mL), bile (1187 ng/mL), and vitreous humor (734 and 875 ng/mL in left and right samples, respectively). GC in conjunction with high resolution mass spectrometry was used to investigate 4-MPD metabolites. Online user testimonies were used to collect information on 4-MPD’s use and effects due to the lack of available data. The toxicity is demonstrated by this case.

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