Cutaneous foreign body granulomas associated with intravenous drug abuse

An Unusual Case of Livedoid and Necrotic Lesions in a Drug Addict

“…13 As drug injections are generally performed in veins, that is downstream the cutaneous capillary filter, there are very few reports of dermatological lesions caused by foreign bodies. 2,4,7,14,15 Our observation of foreign bodies in the capillaries of skin is thus consistent with a diagnosis of intra-arterial injections.…”

“…5 In skin specimens, foreign body reactions do not always take place and, when present, consist in the presence of histiocytes (including epithelioid hystiocytes), multinucleate 4,14 Differential diagnosis of these granulomas can be excluded when a foreign body is found. Polarization microscopy is helpful in this regard.…”

The granulomatous reaction pattern

“…555 Multiple linear nodules, composed of granulomas of foreign body type, have developed along the superficial veins on both arms in an HIV-positive intravenous drug user treated with HAART. 558 The elemental nature of unknown inorganic material can be determined using energy-dispersive X-ray analysis techniques if necessary. 557 Incidentally, it is not well known that cryptococci may also be bi refringent in polarized light.…”

Foreign Body Granulomas

“…In one reported case, the granulomatous reaction developed against the titanium alloy used in the ear piercing. 120 136,137 Plant, 138 wood, and steal splinters 139 Fragments of a chain saw blade 140 Sea urchin spines 141 Wheat stubble 142 Pencil lead 143,144 Artificial hair 145 Golf club graphite 146 Insect fragments after arthropod bites 147 At the points of entry of needles coated with silicone for acupuncture, catheters, and venepunctures [148][149][150] Retained epicardial pacing wires 151,152 Materials used to cut heroin and other addictive drugs 153 The diagnosis of these foreign body reactions is usually establish histopathologically, but the elemental nature of the unknown inorganic material can be determined using energy-dispersive x-ray analysis techniques if necessary. It is also recommended to perform stains for bacteria and fungi to exclude contaminating organisms when foreign bodies, such as wood splinters or bone fragments, are found.…”