Upper Extremity Soft Tissue Wound Related to Xylazine-laced Fentanyl Intravenous (IV) Drug Abuse: A Case Report

Abstract

A 35-year-old male abusing intravenous (IV) xylazine-laced fentanyl presented with bilateral forearm wounds. His wounds extended from the wrist to the proximal forearm with exposed muscles and tendons. He was treated with intravenous antibiotics, multiple surgical debridements, and negative pressure wound therapy. He left against medical advice (AMA) and returned with similar, smaller wounds nine months later. The patient was treated and again left AMA and has not followed up since. Xylazine is a veterinary tranquilizer often added to fentanyl to prolong and enhance its effects, whose presence has markedly increased in the illicit drug markets in the United States. It can result in extensive tissue loss from direct toxicity of the drug and/or concomitant infection. Xylazine use may increase morbidity in persons who inject drugs relating to the high prevalence of skin ulcers, soft tissue abscesses, and risk of serious infection necessitating surgical management.

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to opioid antagonism

“…κOR distribution in human skin has led to its study as a therapeutic target [ 95 – 97 ], suggesting new directions for research into wound etiology. Separately, withdrawal symptoms specific to pentazocine include heightened anxiety, agitation, and paranoia [ 98 ]; these are also cited by clinicians and people who use drugs to be distinguishing presentations of xylazine withdrawal, increasing the difficulty of initiating medication assisted therapy for opioid dependence [ 14 , 99 , 100 ]. Further investigations are needed to establish if similarities to skin ulcers and withdrawal are coincidental or may be mediated in part by κOR.…”