Ingestion of even small amounts of MDMA ('ecstasy') by a small subset of the population may result in a potentially fatal clinical syndrome of severe hyperpyrexia, cardiovascular collapse, coagulopathy, rhabdomyolysis and multiple organ failure. Rapid and aggressive temperature control is of utmost importance in the management of these patients. We report a case of MDMA toxicity presenting with severe hyperpyrexia (43 degrees C) who survived after a rapid reduction in temperature to 36 degrees C within 60 minutes following active surface cooling, cooled (approximately 4 degrees C) intravenous solutions, urinary and gastric lavage solutions and replacement fluids for continuous veno-venous diafiltration.