Cocaine induced midline destructive lesions

Trimarchi, Matteo; Bertazzoni, G.; Bussi, Mario

doi:10.4193/rhin13.112

Cited by 32 publications

(18 citation statements)

References 52 publications

(119 reference statements)

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“…ANCA positive 31%-58% 26,37 MPO ANCA positive 25%-50% 26,47 ENT involvement 48%-96% 37,38 Rhinologic CRSwNP 42%-51% 37,38 Change in sense of smell 40% 47 Nasal crusting 8%-43% 47,48 Otologic OME/CHL 3%-12% 26 59 although the importance of abstinence from cocaine for a good outcome cannot be overstated.…”

Section: Prevalence Of Ent Features Of Eosinophilic Granulomatosis Wimentioning

confidence: 99%

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Coates

Pero

2020

Clinical Otolaryngology

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ENT involvement is common in ANCA-associated vasculitis (AAV), particularly in GPA and EGPA. Early recognition and treatment is important for good outcomes, yet evidence suggests that UK ENT surgeons may not consistently recognise the early features of AAV, despite a similar incidence to vestibular schwannoma. AAV is a rapidly advancing field, with significant developments in the understanding of its pathogenesis, classification and treatment over the past decade. Relevant vasculitis mimics are also discussed with a particular focus on the increasing prevalence of vasculitis mimics driven by an increase in recreational cocaine use, as well as the emergence and reclassification of several other vasculitis mimics in the head and neck. This article reviews key recent updates in the vasculitis literature, with a particular focus on those relevant to recognition and diagnosis of AAV for the ENT surgeon. Strengths and limitations of relevant diagnostic testing are discussed, and a method of evaluation of patients with features of AAV presenting to ENT services is outlined. | 317

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Section: Prevalence Of Ent Features Of Eosinophilic Granulomatosis Wimentioning

confidence: 99%

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Coates

Pero

2020

Clinical Otolaryngology

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“…Variance among the likelihood of cocaine users who develop CIMDL corroborates this conclusion. As Trimarchi et al's noted, vasoconstriction and mechanical irritation should affect all cocaine users similarly, but only 4.8% of regular intranasal cocaine users develop NSP [1]. The low frequency of CIMDL among cocaine users also suggests that an additional unidentified or overlooked factor may contribute to the pathogenesis of these lesions.…”

Section: Discussionmentioning

confidence: 96%

“…Necrosis and perforation of the nose and palate due to intranasal cocaine abuse have been well documented. The pathogenesis of these cocaine induced midline destructive lesions (CIMDL) [1] is commonly considered to be mediated by vasoconstriction [2,3], but this classical description may be incomplete. More recently, NSP and midline destructive lesions mimicking CIMDL have been reported as consequences of intranasal use of non-vasoconstrictive drugs such as oxycodone [4], hydrocodone [5] and acetaminophen [6].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, NSP and midline destructive lesions mimicking CIMDL have been reported as consequences of intranasal use of non-vasoconstrictive drugs such as oxycodone [4], hydrocodone [5] and acetaminophen [6]. Considering that few cocaine users ultimately develop CIMDL [1] and that nonvasoconstrictive drugs can produce clinically identical lesions, ischemic necrosis may not completely explain the pathogenesis of CIMDL.…”

Section: Introductionmentioning

confidence: 99%

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Heroin-induced nasal necrosis and septal perforation

Zhang

Patel

Cass

et al. 2017

Acta Oto-Laryngologica Case Reports

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We present the case of a 44-year-old woman with a 28-year history of intranasal heroin use who developed severe necrosis of the nasal mucosa and septal perforation. She denied any prior insufflation of cocaine or other substances. Necrosis of the septum was recurrent and persistent despite repeated debridement. Necrosis and perforation of the nose and palate are welldescribed consequences of intranasal cocaine abuse, often attributed to cocaine's vasoconstrictive properties. However, there have been few reports of similar effects associated with heroin. This case and other recent reports of non-vasoconstrictive substances causing nasal and palatal necrosis suggest that vasoconstriction alone may be an incomplete explanation for the pathogenesis of cocaine induced midline destructive lesions (CIMDL). Cocaine and other recreational drugs, including heroin, may cause midline destruction through a common non-vasoconstrictive mechanism, possibly mediated by antineutrophil cytoplasmic antibodies. ARTICLE HISTORY

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“…with cocaine necrosis normally confined to nasal septal destruction (10) . Conversely, the described levamisole-induced necrosis is more widespread, characterised by its extension posteriorly and into the lateral walls of the nasal cavity.…”

Section: Discussionmentioning

confidence: 99%

Cocaine contaminant Levamisole-induced polyangiitis and necrosis of the nasal cavity – a Scottish case series

Andrew¹,

Scott²,

Kochman³

et al. 2019

RHINOL

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Background: Common cocaine cutting agent Levamisole is known to cause agranulocytosis. However, a lesser known public health issue is levamisole-induced granulomatosis with polyangiitis. This case series explores this link. Methods and Results:A three case-series report with findings confirmed through clinical history, examination, biopsy and urine toxicology screens. Conclusions:Our case-series highlights a possible link between levamisole and extensive necrosis of the nasal cavity; caused by polyangiitis with granuloma formation and secondary vasculitis. A high degree of suspicion is needed if young patients present with ANCA positive vasculitis, or in patients with cocaine use, if there is a disproportionate destruction of tissues-particularly the lateral wall of the nose. If diagnosed and treated early, this can be lifesaving.

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Cocaine induced midline destructive lesions

Abstract: CIMDL must be readily recognized by clinicians to provide appropriate treatment. Immunosuppressive therapy has no role in the treatment of CIMDL. Only abstinence can interrupt the progression of the disease.

Cited by 32 publications

References 52 publications

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Heroin-induced nasal necrosis and septal perforation

Cocaine contaminant Levamisole-induced polyangiitis and necrosis of the nasal cavity – a Scottish case series

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