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Dar T, Abou-Abdallah M, Michaels J, Talwar R. Cocaine-associated Eustachian tube stenosis causing chronic 'glue ear': a rare cocaine-induced destructive lesion. J Laryngol Otol 2024; 138:699-702. [PMID: 38326948 DOI: 10.1017/s0022215124000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate - termed cocaine-induced midline destructive lesions. CASE REPORT A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. CONCLUSION This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available.
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Affiliation(s)
- Talib Dar
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
| | | | - Joshua Michaels
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
| | - Rishi Talwar
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
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2
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Pendolino AL, Benshetrit G, Navaratnam AV, To C, Bandino F, Scarpa B, Kwame I, Ludwig DR, McAdoo S, Kuchai R, Gane S, Saleh H, Pusey CD, Randhawa PS, Andrews PJ. The role of ANCA in the management of cocaine-induced midline destructive lesions or ENT pseudo-granulomatosis with polyangiitis: a London multicentre case series. Laryngoscope 2024; 134:2609-2616. [PMID: 38084793 DOI: 10.1002/lary.31219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management. METHODS A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected. RESULTS Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups. CONCLUSIONS A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term "cocaine-induced ENT pseudo-GPA" instead of CIMDL. LEVEL OF EVIDENCE IV Laryngoscope, 134:2609-2616, 2024.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
- Ear Institute, UCL, London, UK
| | - Guy Benshetrit
- Department of ENT, Imperial College Hospitals, London, UK
| | | | - Caroline To
- Department of Allergy, Royal Brompton Hospital, London, UK
- Department of Immunology and Allergy, Princess Alexandra Hospital, Brisbane, Australia
| | - Fabrizio Bandino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, Padova, Italy
| | - Ivor Kwame
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Dalia R Ludwig
- Rheumatology Department, University College London Hospitals, London, UK
| | - Stephen McAdoo
- Department of ENT, Imperial College Hospitals, London, UK
| | - Romana Kuchai
- Department of ENT, Imperial College Hospitals, London, UK
| | - Simon Gane
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Hesham Saleh
- Department of ENT, Imperial College Hospitals, London, UK
| | - Charles D Pusey
- Department of ENT, Imperial College Hospitals, London, UK
- Renal Department, Imperial College Hospitals, London, UK
| | - Premjit S Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Peter J Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
- Ear Institute, UCL, London, UK
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3
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Aseem F, Lin V, Gilbert AL, Rivadeneira AC, Jennette JC, Bouldin TW, Khoshbakht F, Lee YZ, Chamberlin K, Gelinne A, Mehrabyan AC, Javed B, Dujmovic Basuroski I, Diaz MM. ANCA-associated vasculitis presenting with isolated neurological manifestations in a patient with cocaine abuse: a case report and literature review. Clin Rheumatol 2024; 43:1401-1407. [PMID: 38416306 DOI: 10.1007/s10067-024-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare conditions predominantly affecting small vessels of skin, musculoskeletal, pulmonary, renal, and rarely central and peripheral nervous systems. Isolated neurological manifestations of AAV are uncommon and challenging to diagnose. Cocaine has been reported as a potential trigger for the development of AAV. There are only a few case reports of isolated neurological involvement in cocaine-induced AAV with poorly characterized histopathological features. We present a unique case of AAV with isolated neurological manifestations presenting with multiple cranial neuropathies, leptomeningeal enhancement on imaging and histopathologic evidence of small-vessel vasculitis in the leptomeninges and brain and extensive dural fibrosis in a patient with cocaine abuse. The patient's progressive neurological deficits were controlled after starting immunosuppression with rituximab and prednisone. We also reviewed the literature to provide the diagnostic overview of AAV and evaluate intervention options. To our knowledge, this is the first case of AAV with isolated neurological manifestations and histopathologic evidence of small-vessel vasculitis in a patient with cocaine abuse. Patients with multiple cranial neuropathies and meningeal involvement should be screened for AAV, especially if they have a history of cocaine abuse.
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Affiliation(s)
- Fazila Aseem
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Victor Lin
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Abigail L Gilbert
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Alfredo C Rivadeneira
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Freshta Khoshbakht
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Anahit C Mehrabyan
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Bushra Javed
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Irena Dujmovic Basuroski
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Monica M Diaz
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA.
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Puac-Polanco P, Rovira À, Shah LM, Wiggins RH, Rivas Rodriguez F, Torres C. Imaging of Drug-Related Vasculopathy. Neuroimaging Clin N Am 2024; 34:113-128. [PMID: 37951697 DOI: 10.1016/j.nic.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Illicit and recreational drugs, such as cocaine, heroin, amphetamines, and marijuana, can result in drug-related vasculitis or vasculopathy. Similarly, the use of certain antithyroid, oncologic, and immunosuppressive medications for therapeutic purposes can lead to vasculopathy. This in turn may result in significant complications in the central nervous system, including intracranial hemorrhage and stroke. Cocaine abuse can also lead to midline destructive lesions of the sinonasal complex. MR imaging, Vessel Wall imaging, and CT/CTA are valuable imaging tools for the evaluation of patients with suspected drug-induced vasculopathy or vasculitis. This article reviews the pathomechanism, clinical presentation, and imaging findings of vasculopathy related to drug abuse and prescribed medications.
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Affiliation(s)
- Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Hospital Vall d'Hebron Passeig Vall d'Hebron 119-129 08035 Barcelona, Spain
| | - Lubdha M Shah
- Division of Neuroradiology, University of Utah, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Richard H Wiggins
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, University of Utah Health Sciences Center, 50 Medical Drive North, Salt Lake City, UT 84132, USA
| | - Francisco Rivas Rodriguez
- Radiology, Division of Neuroradiology, University of Michigan, 1500 East Medical Center Drive, B2A205 Ann Arbor, MI 48109-5302, USA
| | - Carlos Torres
- Department of Radiology, Radiation Oncology and Medical Physics, Box 232, General Campus Room 1466e, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada.
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5
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Thijs E, Hurley D, Cummings B, Elewaut D, Verougstraete N, Claerhout I, Murphy CC, Power W, Roels D. Levamisole-Adulterated Cocaine-Induced Mucous Membrane Pemphigoid: Case Reports and Literature Review. Cornea 2024:00003226-990000000-00472. [PMID: 38294898 DOI: 10.1097/ico.0000000000003481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The aim of this study was to report 2 cases of levamisole-adulterated cocaine-induced mucous membrane pemphigoid. METHODS This study is a review of case reports and literature. RESULTS Two patients presented with bilateral severe purulent conjunctivitis, corneal ulceration, and rapidly progressive forniceal shortening. Both patients were active cocaine users. A complete blood analysis showed a positive antineutrophil cytoplasmic antibody immunofluorescence with a mixed perinuclear antineutrophil cytoplasmic antibody and cytoplasmic-staining antineutrophil cytoplasmic antibody pattern. Direct immunofluorescence examination of conjunctival tissue showed linear deposition of component 3 and immunoglobulins at the basal membrane. A diagnosis of levamisole-adulterated cocaine-induced mucous membrane pemphigoid was made. In case 1, this suspicion was confirmed by investigating remnants of cocaine on the patient's debit card using mass spectrometry, which contained traces of levamisole. In both cases, aggressive immunosuppressive therapy combining systemic corticosteroids and rituximab was able to control the disease. However, by the time these therapies were initiated, significant corneal injury had occurred requiring corneal grafts in both patients. CONCLUSIONS Given the rising abuse of cocaine, it is important that ophthalmologists are made aware of its association with severe atypical cicatricial conjunctivitis. To the best of our knowledge, we present the first case proving the causal relationship between levamisole and ocular cicatricial pemphigoid.
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Affiliation(s)
- Elke Thijs
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Daire Hurley
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Brendan Cummings
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Nick Verougstraete
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Ilse Claerhout
- Department of Ophthalmology, AZ Maria Middelares Hospital, Ghent, Belgium; and
| | - Conor C Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - William Power
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Dimitri Roels
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
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6
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Ruffer N, Krusche M, Holl-Ulrich K, Kötter I, Lötscher F. [Cocaine-induced vasculitis and mimics of vasculitis]. Z Rheumatol 2023; 82:606-614. [PMID: 35612660 PMCID: PMC10495486 DOI: 10.1007/s00393-022-01217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Cocaine is a psychotropic tropane alkaloid and stimulant drug. Nasal insufflation of cocaine powder is a common route of administration. In Germany, cocaine is frequently adulterated with levamisole, an anthelminthic drug with immunomodulatory effects. Both substances are linked to various autoimmune conditions. Cocaine-induced midline destructive lesions cause a progressive destruction of osteocartilaginous structures within the upper respiratory tract and can mimic localized granulomatosis with polyangiitis. In addition, systemic vasculitis due to cocaine and levamisole has been reported. Differentiation of these conditions from primary vasculitis can be challenging because antineutrophil cytoplasmic antibodies (ANCA) are commonly detected. Early diagnosis of these conditions is crucial as clinical improvement is closely related to drug cessation.
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Affiliation(s)
- Nikolas Ruffer
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland.
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Konstanze Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Pathologie-Hamburg, Labor Lademannbogen MVZ GmbH, Hamburg, Deutschland
| | - Ina Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Fabian Lötscher
- Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
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7
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Springer JM, Villa-Forte A. Vasculitis Mimics and Other Related Conditions. Rheum Dis Clin North Am 2023; 49:617-631. [PMID: 37331736 DOI: 10.1016/j.rdc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The approach to diagnosis of primary systemic vasculitis can be challenging, often requiring consideration of important secondary causes of vasculitis and non-inflammatory mimics. An atypical pattern of vascular involvement and/or atypical features of primary vasculitis (eg, cytopenia, lymphadenopathy) should prompt a more thorough investigation into other diseases. Herein, we review selected mimics organized by the size of blood vessels typically affected.
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Affiliation(s)
- Jason M Springer
- Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 Medical Center North, Nashville, TN 37232-2681, USA.
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8
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Wasserman I, Chari DA, Gray ST, Naunheim MR, Miloslavsky EM. Ear, Nose, and Throat Manifestations of Vasculitis and Other Systemic Autoimmune Diseases: Otologic, Sinus, and Airway. Rheum Dis Clin North Am 2023; 49:633-645. [PMID: 37331737 DOI: 10.1016/j.rdc.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Auricular, nasal, and laryngeal manifestations occur frequently in rheumatic diseases. Inflammatory ear, nose, and throat (ENT) processes often result in organ damage and have profound effects on quality of life. Herein, we review the otologic, nasal, and laryngeal involvement of rheumatic diseases, focusing on their clinical presentation and diagnosis. ENT manifestations generally respond to treatment of the systemic disease, which is outside the scope of this review; however, adjunctive topical and surgical treatment approaches, as well as treatment of idiopathic inflammatory ENT manifestations will be reviewed.
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Affiliation(s)
- Isaac Wasserman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Divya A Chari
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology, University of Massachusetts Memorial Health Center, Worcester, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Matthew R Naunheim
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Eli M Miloslavsky
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Bucur P, Weber M, Agrawal R, Madera-Acosta AI, Elam RE. Pulmonary-Renal Syndrome from Levamisole-Adulterated Cocaine-Induced Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review. Pharmaceuticals (Basel) 2023; 16:846. [PMID: 37375793 DOI: 10.3390/ph16060846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Levamisole is an anti-helminthic drug with immunomodulatory properties that is added to cocaine to increase its potency and weight. Levamisole-adulterated cocaine (LAC) may cause an antineutrophil cytoplasmic antibody (ANCA)-associated systemic small vessel vasculitis (AAV). We aimed to characterize the phenotype of persons developing pulmonary-renal syndrome (PRS) in LAC-induced AAV and summarize its treatment and outcomes. Pubmed and Web of Science were searched (until September 2022). Reports that described co-existing diffuse alveolar hemorrhage and glomerulonephritis in an adult (age ≥ 18) with confirmed or suspected LAC exposure were included. Reports, demographics, clinical and serologic features, treatment and outcome characteristics were extracted. Of the 280 records identified, eight met the inclusion criteria, including eight unique cases. Persons were aged 22-58 years, and 50% were women. Cutaneous involvement occurred in only half of the cases. Other associated vasculitis findings and serologies were heterogeneous. All patients received immunosuppression with steroids, with cyclophosphamide and rituximab commonly added. We concluded that PRS could occur from LAC-induced AAV. Distinguishing LAC-induced AAV from primary AAV is challenging as clinical and serologic presentations overlap. Asking about cocaine use is requisite in persons presenting with PRS to guide diagnosis and appropriately counsel on cocaine cessation in conjunction with immunosuppression as treatment.
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Affiliation(s)
- Philip Bucur
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA 30901, USA
| | - Marshall Weber
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Rashi Agrawal
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | | | - Rachel E Elam
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA 30901, USA
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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10
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Sánchez-Puigdollers A, Just-Sarobé M, Pastor-Jané L. Cutaneous and Mucosal Conditions Associated With Cocaine Use. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:125-131. [PMID: 36115385 DOI: 10.1016/j.ad.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments.
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Affiliation(s)
| | - M Just-Sarobé
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, España
| | - L Pastor-Jané
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, España
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11
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Sánchez-Puigdollers A, Just-Sarobé M, Pastor-Jané L. [Translated article] Cutaneous and Mucosal Conditions Associated With Cocaine Use. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T125-T131. [PMID: 36470395 DOI: 10.1016/j.ad.2022.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments.
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Affiliation(s)
| | - M Just-Sarobé
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - L Pastor-Jané
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain
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12
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van Leuven SI. Hidden in plain sight: how to look behind the veil of cocaine-induced vasculitis. Rheumatol Adv Pract 2023; 7:rkad047. [PMID: 37207269 PMCID: PMC10191674 DOI: 10.1093/rap/rkad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Sander I van Leuven
- Correspondence to: Sander I. van Leuven, Department of Rheumatology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands. E-mail:
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13
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DI COSOLA M, SEMBRONIO S, DIOGUARDI M, ROBIONY M, DIAZ-FLORES GARCIA V, PUCCI R, DELLA MONACA M, LO MUZIO L, SPIRITO F, BRAUNER E, PIACENTILE KA, NOCINI R, COPELLI C. The clinical manifestations of cocaine-induced midline destructive lesion: a real challenge for maxillo-facial surgeons, mapping evidence review. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Ortiz-Seller A, Hernández-Pons A, Pascual EV, Comín Pérez A, Dolz Gaitón R, Albert-Fort M. Severe Cocaine-Induced Midline Destructive Lesions (CIMDL) Leading to Orbital Apex Syndrome and Peripheral Ulcerative Keratitis. Ocul Immunol Inflamm 2022; 30:1956-1960. [PMID: 33872101 DOI: 10.1080/09273948.2021.1906913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe a case of cocaine-induced midline destructive lesions (CIMDL) associated with ocular autoimmune disease.Methods: Observational case report. RESULTS A 45-year-old man with history of chronic osteolytic sinusitis due to cocaine abuse presented with sudden vision loss in right eye. Ophthalmic examination revealed fixed right mydriasis with extraocular movements limitation and optic disc swelling. Computed tomography showed an orbital infiltrating mass. The diagnosis of orbital-apex syndrome secondary to CIMDL was established. Steroids and antibiotics therapy were started without vision improvement. At 6-months follow-up, a corneal ulcer with characteristics of peripheral ulcerative keratitis (PUK) was evidenced, coinciding with an upper respiratory bacterial infection. CONCLUSIONS CIMDL and PUK share common pathogenic pathways, with implication of autoimmune factors and exposure to infective antigens. We hypothesized that chronic cocaine use, along with persistent bacterial infection, could have triggered an inflammatory reaction, which contributed to CIMDL development and the appearance of PUK.
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Affiliation(s)
- Amparo Ortiz-Seller
- Department of Ophthalmology, Hospital Universitari Doctor Peset, Valencia, Spain
| | | | - Elia Valls Pascual
- Department of Rheumatology, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Alberto Comín Pérez
- Department of Ophthalmology, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Raquel Dolz Gaitón
- Department of Pathology, Hospital Universitari Doctor Peset, Valencia, Spain
| | - Mara Albert-Fort
- Department of Ophthalmology, Hospital Universitari Doctor Peset, Valencia, Spain
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15
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Nitro L, Pipolo C, Fadda GL, Allevi F, Borgione M, Cavallo G, Felisati G, Saibene AM. Distribution of cocaine-induced midline destructive lesions: systematic review and classification. Eur Arch Otorhinolaryngol 2022; 279:3257-3267. [PMID: 35138441 PMCID: PMC9130192 DOI: 10.1007/s00405-022-07290-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022]
Abstract
Purpose Intranasal cocaine is known to potentially lead to midline destructive lesions. The present systematic review was undertaken to systematically define the localization of cocaine-induced midline destructive lesions and their prevalence and to propose a practical classification of these lesions. Methods A PRISMA-compliant systematic review was performed in multiple databases with criteria designed to include all studies published until March 2021 providing a precise definition of cocaine-induced midline lesions in humans. We selected all original studies except case reports. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for lesion localization, patients’ demographics, exposure to cocaine, and relationship with external nose destruction. Results Among 2593 unique citations, 17 studies were deemed eligible (127 patients). All studies were retrospective case series. The destructive process determined a septal perforation in 99.2% of patients. The distribution prevalence decreased from the inferior third of the sinonasal complex (nasal floor and inferolateral nasal wall, respectively, 59% and 29.9% of patients) to the middle third (middle turbinate and ethmoid, 22.8% of patients), and ultimately to neurocranial structures (7.9% of patients). Nasal deformities were inconsistently reported across reviewed studies. Cocaine use duration, frequency, and status were reported only occasionally. Conclusion Based on the distribution prevalence observed, we propose a four-grade destruction location-based classification. Future prospective studies following the evolution of cocaine-induced lesions are needed to validate our classification, its relationship with lesion evolution, and whether it represents a reliable tool for homogeneous research results reporting.
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Affiliation(s)
- Letizia Nitro
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Gian Luca Fadda
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Fabiana Allevi
- ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.,Maxillofacial Surgery Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mario Borgione
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, San Luigi Gonzaga University Hospital, Università degli Studi di Torino, Turin, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Via Antonio di Rudinì, 8, 20142, Milan, Italy. .,ISGOS, the Italian Study Group on Odontogenic Sinusitis, Milan, Italy.
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16
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Trimarchi M, Bertazzoni G, Vinciguerra A, Pardini C, Simeoni F, Cittaro D, Bussi M, Lazarevic D. Gene Expression Analysis in Patients with Cocaine-Induced Midline Destructive Lesions. ACTA ACUST UNITED AC 2021; 57:medicina57090861. [PMID: 34577784 PMCID: PMC8469603 DOI: 10.3390/medicina57090861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Cocaine users may present with positive antineutrophil cytoplasmic antibodies (ANCA) and severe midline destructive lesions (CIMDL) which are histologically characterized by massive apoptosis. However, histopathological and laboratory studies suggest that autoimmunity may not be the main pathogenic driver. We analyzed gene expression both in cell lines of nasal mucosa exposed to cocaine and in CIMDL patients to determine whether genetic predisposition might cause such lesions, which are observed in a minority of cocaine abusers. MATERIALS AND METHODS The genetic expression profile of nasal mucosa exposed to cocaine was analyzed. Rare variants of expressed genes were searched in patients with CIMDL using exome sequencing and bio-informatics. RESULTS We identified 462 genes that were induced by cocaine, mainly related to apoptosis and autophagy in response to oxidative stress. Under the hypothesis that genes linked to the phenotype are also induced by cocaine itself, a rare variants burden test was performed to select genes that were significantly enriched in rare mutations. Next, 11 cocaine abusers with CIMDL and no other relevant medical comorbidities underwent exome sequencing, and 12 genes that were significantly enriched in the burden test and present in at least 10 patients were identified. An in-depth analysis of these genes revealed their involvement in apoptosis, tissue homeostasis, autophagy, and response to oxidative stress. CONCLUSIONS Oxidative stress and rare genetic alterations in the response to reactive oxygen species, apoptosis, autophagy, and tissue regeneration are plausible drivers of damage affecting nasal mucosa exposed to cocaine crystals and, consequently, the pathogenic mechanism behind CIMDL.
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Affiliation(s)
- Matteo Trimarchi
- Department of Otorhinolaryngology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.V.); (M.B.)
- Correspondence: ; Tel.: +39-02-2643-3522
| | - Giacomo Bertazzoni
- Department of Otorhinolaryngology, Azienda Socio-Sanitaria Territoriale di Cremona, 26100 Cremona, Italy;
| | - Alessandro Vinciguerra
- Department of Otorhinolaryngology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.V.); (M.B.)
| | - Celia Pardini
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.P.); (F.S.); (D.C.); (D.L.)
| | - Fabio Simeoni
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.P.); (F.S.); (D.C.); (D.L.)
| | - Davide Cittaro
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.P.); (F.S.); (D.C.); (D.L.)
| | - Mario Bussi
- Department of Otorhinolaryngology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.V.); (M.B.)
| | - Dejan Lazarevic
- Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (C.P.); (F.S.); (D.C.); (D.L.)
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17
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Dadhwal R, Bulathsinghala CP, Choudhry I, Taweesedt PT, Surani S. Cocaine-Induced Bronchial Laceration: A Rare Incidence. Cureus 2021; 13:e14252. [PMID: 33959440 PMCID: PMC8093120 DOI: 10.7759/cureus.14252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tracheobronchial injuries are either traumatic or iatrogenic but can be lethal in a high dependency setting if not managed promptly. There are few reported cases of cocaine-induced airway damage and barotrauma due to thermal or ischemic injury and increased intra-alveolar pressure. We present a sui generis case of cocaine-induced bronchial laceration with pneumomediastinum which was challenging to diagnose based on the patient’s recent history of hospitalization, as well as the patient’s reluctance to share the history of cocaine use. The patient was successfully managed conservatively. Here, we discuss the mechanism involved and the various treatment options available, along with the role of early involvement of the multidisciplinary team to deliver the best possible outcome.
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Affiliation(s)
- Rahul Dadhwal
- Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | | | - Irfan Choudhry
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | | | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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18
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Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063219. [PMID: 33804629 PMCID: PMC8003646 DOI: 10.3390/ijerph18063219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/05/2022]
Abstract
Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.
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19
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García-Pérez D, Ruiz-Ortiz M, Panero I, Eiriz C, Moreno LM, García-Reyne A, García A, Martín-Medina P, Salvador-Álvarez E, Hernández-Lain A, Serrano A, Gil-Etayo FJ, Castaño-León AM, Paredes I, Pérez-Núñez Á. Snorting the Brain Away: Cerebral Damage as an Extension of Cocaine-Induced Midline Destructive Lesions. J Neuropathol Exp Neurol 2021; 79:1365-1369. [PMID: 33146379 DOI: 10.1093/jnen/nlaa097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cocaine consumption is associated with a variety of clinical manifestations. Though cocaine intranasal inhalation always determines nasal mucosal damages, extensive septum perforations, and midline destructions-known as cocaine-induced midline destructive lesions (CIMDL)-affect only a limited fraction of patients. CIMDL is viewed as a cocaine-associated autoimmune phenomenon in which the presence of atypical anti-neutrophil cytoplasmic antibody (ANCA) promotes and/or defines the disease phenotype. A 51-year-old man presented with an intracranial tumor-like lesion by its space-occupying effect. CT also revealed the destruction of the nasal septum and skull base. A diagnosis of CIMDL was made in light of the patient's history as well as findings of the physical and endoscopic examinations, imaging studies, and laboratory testing. There was no evidence of other pathologies. Histopathological results from cerebral biopsy led us to consider the intracranial pathology as an extension of the CIMDL. CIMDL is the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of predisposed patients. The reported case is the first CIMDL consistent with brain extension mimicking a tumor-like lesion. While the presence of atypical ANCA seems to promote and/or define the disease phenotype, the specific role of these and other circulating autoantibodies needs further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Serrano
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
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20
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Phillips R, King M, McGilligan JA, Hajela V, Allan K. A retrospective review of four patients with severe nasal destruction secondary to cocaine adulterated with levamisole. Clin Otolaryngol 2021; 46:673-678. [PMID: 33386680 DOI: 10.1111/coa.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/24/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rupert Phillips
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Matthew King
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Vijay Hajela
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kimberley Allan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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21
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Underner M, Peiffer G, Perriot J, Jaafari N. Republication de : Complications pulmonaires chez les consommateurs de cocaïne. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2020. [DOI: 10.1016/j.jeurea.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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22
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Csernok E, Hellmich B. ANCA-Diagnostik bei Vaskulitiden. Z Rheumatol 2020; 79:669-678. [DOI: 10.1007/s00393-020-00805-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Blaison F, Faganello D, Goigoux C, Mercié P, Baulier G, Contin-Bordes C, Duffau P. Cocaïne et lésions destructrices centro-faciales : à propos d'un cas. Rev Med Interne 2020; 41:622-627. [PMID: 32660858 DOI: 10.1016/j.revmed.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/30/2020] [Accepted: 04/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed. CASE REPORT A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made. CONCLUSION CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.
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Affiliation(s)
- Félix Blaison
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France.
| | - Déborah Faganello
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Camille Goigoux
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Patrick Mercié
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Gildas Baulier
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Cécile Contin-Bordes
- Laboratoire d'immunologie et immunogénétique, hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, France
| | - Pierre Duffau
- Service de médecine interne et immunologie clinique, hôpital Saint-André, CHU de Bordeaux, 1 Rue Jean Burguet, 33000 Bordeaux, France
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24
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Nasal reconstructive surgery for vasculitis affecting the nose: our two-centre international experience. Eur Arch Otorhinolaryngol 2020; 277:3059-3066. [PMID: 32623509 DOI: 10.1007/s00405-020-06180-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/28/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To recommend an international multidisciplinary medical and surgical algorithm of treatment in nasal vasculitis, which will create a more streamlined approach. METHODS A two-centre, international retrospective analysis of granulomatosis with polyangiitis (GPA) and levamisole-associated vasculitis (LAV) cases presenting between 2005 and 2019 was carried out. Demographic data, and surgical and medical treatment were recorded. Patients' signs and symptoms were analysed, and recommended treatment strategies outlined with key surgical procedures described. RESULTS Forty-one GPA patients and 11 LAV patients were included in the study with a mean age of 38.6 and 38.8 years, respectively. A stepwise surgical management approach with reconstructive options is described and includes: (1) examination under general anaesthesia, biopsy, and insertion of silastic nasal splints; (2) septal perforation repair (with caution); (3) mild-to-moderate saddle nose reconstruction with costal cartilage; (4) severe saddle nose reconstruction with osseocartilaginous rib grafts; (5) soft-tissue reconstruction techniques. CONCLUSIONS The management of nasal vasculitis is a particular challenge in facial plastic surgery. It requires a close collaborative approach with a physician skilled in the medical management of vasculitis. Surgery must be planned judiciously, with realistic patient expectations and only after a sustained period of remission. For more severe saddle deformities, the modified osseocartilaginous Andrews technique gives excellent long-term results.
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25
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Pendolino AL, Unadkat S, Zhang H, Pendolino M, Bianchi G, Randhawa PS, Andrews PJ. The role of surgery in antineutrophil cytoplasmic antibody-associated vasculitides affecting the nose and sinuses: A systematic review. SAGE Open Med 2020; 8:2050312120936731. [PMID: 32676189 PMCID: PMC7340348 DOI: 10.1177/2050312120936731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/29/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The ear, nose and throat region has been reported to be one of the commonest sites involved in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis diseases and often precedes the diagnosis of ANCA–associated vasculitis by many months. Although treatment for ANCA–associated vasculitis primarily requires systemic immunosuppressive therapy, there are specific indications for sinonasal surgery during the course of the disease process. The three major roles for surgery in sinonasal vasculitis are to aid diagnosis through biopsy, enable symptom relief and nasal reconstructive surgery consideration when in remission. Purpose: The aim of this systematic review is to provide an overview of the surgical procedures which can be performed in patients with ANCA–associated vasculitis presenting with sinonasal involvement. Materials and methods: A systematic literature search was performed for scientific articles on MEDLINE (PubMed Advanced MEDLINE Search) and EMBASE. The search included all articles up to April 2020. Conclusion: Surgical intervention during the active phase of ANCA–associated vasculitis disease can improve the patient’s symptoms and enable histological diagnosis. The surgical decision to manage the nose requires a multidisciplinary approach involving the vasculitis specialist and the ear, nose and throat surgeon. Nasal reconstruction can be performed to restore form and function but only when the disease is in remission so as to maximise success and minimise complications.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
| | - Samit Unadkat
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Henry Zhang
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Monica Pendolino
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Gerolamo Bianchi
- Division of Rheumatology, Department of Locomotor System, ASL 3, Genoa, Italy
| | - Premjit S Randhawa
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK
| | - Peter J Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London, UK.,Ear Institute, University College London (UCL), London, UK
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26
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Sbroglio LL, Maiolini VM, Rabelo IMMA, Giraldelli GA, Tuccori LP, Cunha RG. Mucocutaneous leishmaniasis in a cocaine user: diagnostic and therapeutic knowledge. Rev Soc Bras Med Trop 2020; 53:e20200040. [PMID: 32578710 PMCID: PMC7310364 DOI: 10.1590/0037-8682-0040-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.
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Affiliation(s)
- Lissiê Lunardi Sbroglio
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Dermatologia, Rio de Janeiro, RJ, Brasil
| | - Viviane Maria Maiolini
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Dermatologia, Rio de Janeiro, RJ, Brasil
| | | | - Gabriela Almeida Giraldelli
- Universidade do Estado do Rio de Janeiro, Programa de Pós-Graduação em Dermatologia, Rio de Janeiro, RJ, Brasil
| | - Luciana Patrícia Tuccori
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Infectologia, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Guimarães Cunha
- Universidade do Estado do Rio de Janeiro, Departamento de Infectologia, Rio de Janeiro, RJ, Brasil
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27
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A case series and literature review on patients with rhinological complications secondary to the use of cocaine and levamisole. The Journal of Laryngology & Otology 2020; 134:440-446. [PMID: 32431257 DOI: 10.1017/s0022215120000894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out. RESULTS Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion. CONCLUSION As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
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28
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Hussaini AS, Black CK, Malekzadeh S, Milmoe GJ. Extensive Sinonasal and Oropharyngeal Necrosis as a Consequence of Adulterated Cocaine with Mimicry of ANCA-Positive Vasculitis. OTO Open 2020; 3:2473974X19894239. [PMID: 32285022 PMCID: PMC7119445 DOI: 10.1177/2473974x19894239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adnan S Hussaini
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Cara K Black
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Otolaryngology-Head & Neck Surgery, Washington DC Veterans Affairs Medical Center Washington, District of Columbia, USA
| | - Gregory J Milmoe
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
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29
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Coates ML, Martinez Del Pero M. Updates in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis for the ENT surgeon. Clin Otolaryngol 2020; 45:316-326. [PMID: 32145151 DOI: 10.1111/coa.13524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 12/31/2022]
Abstract
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.
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A Review of Primary Vasculitis Mimickers Based on the Chapel Hill Consensus Classification. Int J Rheumatol 2020; 2020:8392542. [PMID: 32148510 PMCID: PMC7049422 DOI: 10.1155/2020/8392542] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/07/2020] [Indexed: 12/13/2022] Open
Abstract
Primary systemic vasculitides are rare diseases that may manifest similarly to more commonly encountered conditions. Depending on the size of the vessel affected (large vessel, medium vessel, or small vessel), different vasculitis mimics must be considered. Establishing the right diagnosis of a vasculitis mimic will prevent unnecessary immunosuppressive therapy.
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Underner M, Peiffer G, Perriot J, Jaafari N. [Pulmonary complications in cocaine users]. Rev Mal Respir 2019; 37:45-59. [PMID: 31883817 DOI: 10.1016/j.rmr.2019.11.641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023]
Abstract
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
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Affiliation(s)
- M Underner
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - G Peiffer
- Pneumologie, CHR Metz-Thionville, CHR Mercy, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique Pierre-Deniker, centre hospitalier Henri-Laborit, université de Poitiers, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
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Bacciu A, Ghirelli M, Ingegnoli A, Bozzetti F. Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube. JAMA Otolaryngol Head Neck Surg 2019; 144:846-848. [PMID: 30098140 DOI: 10.1001/jamaoto.2018.1387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrea Bacciu
- Unit of Otolaryngology and Otoneurosurgery, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Michael Ghirelli
- Unit of Otolaryngology and Otoneurosurgery, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Anna Ingegnoli
- Unit of Radiology, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Francesca Bozzetti
- Unit of Radiology, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
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Lovin BD, Gitomer SA, Gallagher KK. Facial Cellulitis and Sinonasal Necrotizing Infection in a Middle-aged Woman. JAMA Otolaryngol Head Neck Surg 2019; 145:576-577. [PMID: 30998828 DOI: 10.1001/jamaoto.2019.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Sarah A Gitomer
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - K Kelly Gallagher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Csernok E. The Diagnostic and Clinical Utility of Autoantibodies in Systemic Vasculitis. Antibodies (Basel) 2019; 8:antib8020031. [PMID: 31544837 PMCID: PMC6640716 DOI: 10.3390/antib8020031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022] Open
Abstract
Considerable progress has been made in understanding the role of autoantibodies in systemic vasculitides (SV), and consequently testing for anti-neutrophil cytoplasmic antibodies (ANCA), anti-glomerular basement membrane antibodies (anti-GBM), and anti-C1q antibodies is helpful and necessary in the diagnosis, prognosis, and monitoring of small-vessel vasculitis. ANCA-directed proteinase 3 (PR3-) or myeloperoxidase (MPO-) are sensitive and specific serologic markers for ANCA-associated vasculitides (AAV), anti-GBM antibodies are highly specific for the patients with anti-GBM antibody disease (formerly Goodpasture’s syndrome), and autoantibodies to C1q are characteristic of hypocomlementemic urticarial vasculitis syndrome (HUVS; anti-C1q vasculitis). The results of a current EUVAS study have led to changes in the established strategy for the ANCA testing in small-vessel vasculitis. The revised 2017 international consensus recommendations for ANCA detection support the primary use PR3- and MPO-ANCA immunoassays without the categorical need for additional indirect immunofluorescence (IIF). Interestingly, the presence of PR3- and MPO-ANCA have led to the differentiation of distinct disease phenotype of AAV: PR3-ANCA-associated vasculitis (PR3-AAV), MPO-ANCA-associated vasculitis (MPO-AAV), and ANCA-negative vasculitis. Further studies on the role of these autoantibodies are required to better categorize and manage appropriately the patients with small-vessel vasculitis and to develop more targeted therapy.
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Affiliation(s)
- Elena Csernok
- Department of Internal Medicine, Rheumatology and Immunology, Vasculitis-Center Tübingen-Kirchheim, Medius Klinik Kirchheim, University of Tübingen, 73230 Kirchheim-Teck, Germany.
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Abstract
Vasculitis mimics need to be differentiated from primary and secondary vasculitides as described in the Chapel Hill nomenclature. The clinical symptomatology resembles that of vasculitis of small and medium, rarely also large vessels and hence imitates the classical vasculitic disorders. Pathogenetically, the causes are partly genetic mutations, embolization syndromes, infections and substance abuse. Also, B‑cell lymphomas can mimic vasculitis. The present manuscript summarizes the vasculitis mimics.
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Affiliation(s)
- I Kötter
- Rheumatologie, Klinische Immunologie, Nephrologie, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Deutschland.
| | - E Reinhold-Keller
- Internistisch-rheumatologische Praxis, Jürgensallee 44, 22609, Hamburg, Deutschland
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The disease of Sigmund Freud: oral cancer or cocaine-induced lesion? Eur Arch Otorhinolaryngol 2018; 276:263-265. [DOI: 10.1007/s00405-018-5173-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
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Trimarchi M, Bondi S, Della Torre E, Terreni MR, Bussi M. Palate perforation differentiates cocaine-induced midline destructive lesions from granulomatosis with polyangiitis. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:281-285. [PMID: 28663599 PMCID: PMC5584099 DOI: 10.14639/0392-100x-1586] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/11/2017] [Indexed: 12/24/2022]
Abstract
Cocaine abuse occasionally causes extensive destruction of the osteocartilaginous structures of the nose, sinuses and palate, which mimics the clinical picture of other diseases associated with necrotising midfacial lesions. The differentiation of cocaine-induced midline destructive lesions (CIMDL) and limited granulomatosis with polyangiitis (GPA) may be difficult, particularly if patients do not readily admit substance abuse. We studied 10 patients with CIMDL and palate perforation referred to our Unit between 2002 and 2015. All cases underwent nasal endoscopy, sinus CT or MRI and ANCA test. In 8 patients, a nasal biopsy was performed. The PubMed database was searched to review all cases of palate perforation described in patients affected by CIMDL or GPA. All 10 cases presented with septal perforation and inferior turbinate destruction. We found hard palate perforation in 7 patients, soft palate perforation in 2 patients, and perforation of both in one patient. ANCA testing was negative in 8 patients and positive in 2, with C-ANCA and P-ANCA specificity, respectively. A review of the English literature identified palate perforation in 5 patients with GPA and in 73 patients with CIMDL. The presence of palate perforation in patients with MDL may represent a clinical marker that strongly favors CIMDL over GPA.
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Affiliation(s)
| | - S Bondi
- Department of Otorhinolaryngology
| | | | - M R Terreni
- Departments of Pathology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milan, Italy
| | - M Bussi
- Department of Otorhinolaryngology
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Trimarchi M, Nicolai P, Lombardi D, Facchetti F, Morassi ML, Maroldi R, Gregorini G, Specks U. Sinonasal Osteocartilaginous Necrosis in Cocaine Abusers: Experience in 25 Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240301700107] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases. Methods From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. Serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase. Results Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti–proteinase 3 antibodies. Conclusion Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. Cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.
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Affiliation(s)
- Matteo Trimarchi
- Departments of Otorhinolaryngology, University of Brescia, Italy
| | - Piero Nicolai
- Departments of Otorhinolaryngology, University of Brescia, Italy
| | - Davide Lombardi
- Departments of Otorhinolaryngology, University of Brescia, Italy
| | | | | | | | | | - Ulrich Specks
- Thoracic Diseases Research Unit and Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
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Westreich RW, Lawson W. Midline Necrotizing Nasal Lesions: Analysis of 18 Cases Emphasizing Radiological and Serological Findings with Algorithms for Diagnosis and Management. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800405] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of this study was to assess the principal signs and symptoms for severe necrotizing midline nasal lesions and give diagnostic and management algorithms. Methods Literature review and retrospective chart review were performed. Three patients with Wegener's granulomatosis (WG), six patients with sarcoid, eight patients with cocaine abuse, and one lymphoma patient were analyzed with respect to symptom complexes, laboratory results, and radiographic findings. Based on computed tomography findings, a nasal destruction score was tabulated for each patient. Results All diseases essentially had similar signs and symptoms within the head and neck but several extranasal sites were suggestive of specific etiologies. Serological laboratory testing was diagnostic in only two of the six sarcoid patients and two of the three WG patients. There were no specific tests associated with lymphoma or cocaine abuse, although erythrocyte sedimentation rate was consistently and significantly elevated in the latter group. Biopsy confirmed disease was found in one of the three sarcoid patients, in one of the three WG patients, and in one out of one of the lymphoma patients. Nasal destruction scores were highest in WG and lymphoma patients, intermediate in cocaine abuse patients, and lowest in patients with sarcoidosis. Two of the three WG patients had extensive neo-osteogenesis. One out of one lymphoma and five of the eight cocaine abuse patients had oronasal or oroantral fistulas. Conclusion Laboratory tests and biopsies were consistently unreliable in all diseases. Repeat studies should be performed in all cases of negative results if clinical suspicion is high. Neo-osteogenesis and mastoid disease were associated with WG when compared with patients with similar levels of nasal destruction due to other etiologies. Laryngeal and dermatologic changes without significant nasal bony abnormalities raised suspicion for sarcoidosis. Hard and soft palate defects were associated with cocaine abuse and extranodal nasal lymphoma.
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Affiliation(s)
| | - William Lawson
- Department of Otolaryngology, Mount Sinai Hospital, New York, New York
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Trimarchi M, Miluzio A, Nicolai P, Morassi ML, Bussi M, Marchisio PC. Massive Apoptosis Erodes Nasal Mucosa of Cocaine Abusers. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240602000207] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A threatening occurrence in some cocaine abusers is the progressive destruction of nasal structures (cocaine-induced midline destructive lesions [CIMDL]) that may end in a highly severe disease. Methods Thirty patients with CIMDL, 10 healthy patients, 10 patients affected by nasal polyposis, and 10 patients affected by Wegener granulomatosis were observed. Biopsy specimens of nasal mucosa were analyzed by immunohistochemistry for caspases −3, −9 and −8 and by the terminal deoxynucleotidyl transferase-mediated dUTP-digoxygenin nick end labeling (TUNEL) method. The time and concentration-dependent effects of cocaine in vitro were studied in HaCat cells by TUNEL and Western blotting. Results All CIMDL biopsy specimens showed abundant caspase-3 and caspase-9 expression but no caspase-8 positive cells. No obvious expression of any caspases was detected in biopsy specimens from healthy subjects or in patients affected by nasal polyposis or Wegener granulomatosis. In HaCat cells cellular changes were observed, which confirmed induction of massive apoptotic events. The rate of apoptosis in HaCat cells was dependent on the concentration of cocaine. After 1 hour, 2.5,5, and 10 mM of cocaine induced 16, 45, and 84% of apoptotic figures, respectively, while 6 hours of exposure increased apoptosis to 25, 54, and 94% at the same concentrations. Caspase expression and activation in HaCat cells treated with 100 μM and 1 mM of cocaine for 1 hour were confirmed by Western blotting. Conclusion Cultured epithelial cells show both time- and dose-dependent increases in apoptosis and cellular damage on cocaine treatment. We suggest that some abusers trigger CIMDL by abnormally boosting apoptosis within nasal epithelial cells. Cocaine abusers with higher apoptotic rates may predict whether they will eventually develop CIMDL.
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Affiliation(s)
- Matteo Trimarchi
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milano, Italy
| | - Annarita Miluzio
- Laboratory of Molecular Histology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milano, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology, Spedali Civili and University of Brescia, Italy
| | | | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milano, Italy
| | - Pier Carlo Marchisio
- Laboratory of Molecular Histology, San Raffaele Hospital and Vita-Salute University San Raffaele, Milano, Italy
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Moreno-Artero E, Querol-Cisneros E, Rodríguez-Garijo N, Tomás-Velázquez A, Antoñanzas J, Secundino F, Pilar Gil-Sánchez M, España A. Mucocutaneous manifestations of cocaine abuse: a review. J Eur Acad Dermatol Venereol 2018; 32:1420-1426. [DOI: 10.1111/jdv.14912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E. Moreno-Artero
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | - E. Querol-Cisneros
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | - N. Rodríguez-Garijo
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | - A. Tomás-Velázquez
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | | | - F. Secundino
- Department of Otorhinolaryngology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | - M. Pilar Gil-Sánchez
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
| | - A. España
- Department of Dermatology; University Clinic of Navarra; University of Navarra, IdiSNA; Navarra Institute for Health Research; Navarra Spain
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Cocaine and ANCA associated vasculitis-like syndromes – A case series. Autoimmun Rev 2018; 17:73-77. [DOI: 10.1016/j.autrev.2017.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022]
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Mansoor K, Kheetan M, Shahnawaz S, Shapiro AP, Patton-Tackett E, Dial L, Rankin G, Santhanam P, Tzamaloukas AH, Nadasdy T, Shapiro JI, Khitan ZJ. Systematic review of nephrotoxicity of drugs of abuse, 2005-2016. BMC Nephrol 2017; 18:379. [PMID: 29287591 PMCID: PMC5747941 DOI: 10.1186/s12882-017-0794-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes. METHODS We conducted a systematic review of published case reports, case series, and cross sectional studies of nephrotoxicities related to drugs of abuse. Literature review was conducted using PubMed/Medline from January 1, 2005 -December 31, 2016 to search for publications related to drug abuse with a defined renal outcome. Publications which reported renal injury in relation to the use of illicit drugs were selected, specifically those cases with raised creatinine levels, clinically symptomatic patients, for instance those with oliguria and proven renal biopsies. RESULTS A total of 4798 publications were reviewed during the search process and PRISMA flow chart and Moose protocol regarding systematic reviews were followed. 110 articles were shortlisted for the review. A total of 169 cases from case reports and case series, and 14 case studies were analyzed. Renal manifestations of specific illicit drug abuse were included in this review. CONCLUSION Based on the evidence presented, a wide range of renal manifestations were found to be associated with drug abuse. If the trend of increasing use of illicit drug use continues, it will put a significant percentage of the population at an elevated risk for poor renal outcomes. This study is limited by the nature of the literature reviewed being primarily case reports and case series.
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Affiliation(s)
- Kanaan Mansoor
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Murad Kheetan
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Saba Shahnawaz
- Aga Khan University Hospital, Stadium Road, Karachi, 74800 Pakistan
| | - Anna P. Shapiro
- The Case Western Reserve University, Cleveland, OH 44106 USA
| | - Eva Patton-Tackett
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Larry Dial
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Gary Rankin
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | | | | | | | - Joseph I. Shapiro
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
| | - Zeid J. Khitan
- Joan C. Edwards School of Medicine, Marshall University, 1690 Medical Center Drive, Huntington, WV 25701 USA
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Zhang D, Patel KB, Cass LM, Foster AE, Guntupalli L, Brunworth JD. Heroin-induced nasal necrosis and septal perforation. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1379354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Donald Zhang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Kunjan B. Patel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Lauren M. Cass
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | | | - Lohitha Guntupalli
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Joseph D. Brunworth
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Saint Louis University, Saint Louis, MO, USA
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Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol 2017; 70:101-113. [PMID: 28662796 DOI: 10.1016/j.jacc.2017.05.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Cocaine is the leading cause for drug-abuse-related visits to emergency departments, most of which are due to cardiovascular complaints. Through its diverse pathophysiological mechanisms, cocaine exerts various adverse effects on the cardiovascular system, many times with grave results. Described here are the varied cardiovascular effects of cocaine, areas of controversy, and therapeutic options.
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Affiliation(s)
- Ofer Havakuk
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shereif H Rezkalla
- Department of Cardiology and Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Robert A Kloner
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institute, Los Angeles, California.
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Abstract
Drugs are associated frequently with the development of various types of acute and chronic kidney diseases. Nephrotoxicity is associated most commonly with injury in the tubulointerstitial compartment manifested as either acute tubular injury or acute interstitial nephritis. A growing number of reports has also highlighted the potential for drug-induced glomerular disease, including direct cellular injury and immune-mediated injury. Recognition of drug-induced nephropathies and rapid discontinuation of the offending agents are critical to maximizing the likelihood of renal function recovery. This review will focus on the pathology and pathogenesis of drug-induced acute interstitial nephritis and drug-induced glomerular diseases.
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Affiliation(s)
- Paisit Paueksakon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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48
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Ocular Penetration Secondary to Cocaine-Induced Midline Destructive Lesion. Ophthalmic Plast Reconstr Surg 2017; 33:e23-e26. [PMID: 25719373 DOI: 10.1097/iop.0000000000000435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Herein, the authors present a retrospective case report of a patient with ocular penetration due to cocaine-induced midline destructive lesion. To their knowledge, this is the first documented case of ocular penetration secondary to cocaine insufflation.
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49
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Guntupalli L, Patel K, Faraji F, Brunworth JD. Autoimmune-related nasal septum perforation: A case report and systematic review. ALLERGY & RHINOLOGY 2017; 8:40-44. [PMID: 28381327 PMCID: PMC5380452 DOI: 10.2500/ar.2017.8.0191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Inflammatory injury of nasal respiratory mucosa is a common feature of multisystem autoimmune disease. Certain autoimmune disorders are associated with nasal septum perforation (NSP). We performed a systematic review of the literature to better understand the association of NSP with specific autoimmune disorders. This is a case report of a 29-year-old woman with a history of arthralgia, autoreactive antibody titers, platelet dysfunction, and NSP. The constellation of symptoms and potential familial involvement indicated that the NSP in this patient was an early sign of an autoimmune disorder, an unknown autoimmune disorder, or a known disease with incomplete penetrance. Methods: A systematic review of the literature was performed by two independent reviewers. Relevant articles were reviewed, and data that pertained to autoimmune-related NSP were extracted and analyzed. Results: Overall, 140 cases of autoimmune-associated NSPs were reported. Granulomatosis with polyangiitis (48%), relapsing polychondritis (26%), and cocaine-induced midline lesions (15%) constituted 89.3% of the reported cases. Conclusion: NSP is a potential sign of systemic disease. The identification of an NSP, especially in the context of other unexplained symptoms or workup suggestive of an autoimmune disorder, should prompt clinical evaluation for multisystem autoimmune disease with consideration of granulomatosis with polyangiitis, relapsing polychondritis, or cocaine-induced midline lesions.
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Affiliation(s)
- Lohitha Guntupalli
- From the Department of Otolaryngology Head and Neck Surgery, School of Medicine, St. Louis University, St. Louis, Missouri
| | - Kunjan Patel
- From the Department of Otolaryngology Head and Neck Surgery, School of Medicine, St. Louis University, St. Louis, Missouri
| | - Farhoud Faraji
- From the Department of Otolaryngology Head and Neck Surgery, School of Medicine, St. Louis University, St. Louis, Missouri
| | - Joseph D. Brunworth
- From the Department of Otolaryngology Head and Neck Surgery, School of Medicine, St. Louis University, St. Louis, Missouri
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Swe T, Pervil-Ulysse M, Baqui AA. Cocaine-induced vasculitis with cutaneous manifestation: A recurrent episode after 2 years. J Family Med Prim Care 2017; 5:712-715. [PMID: 28217616 PMCID: PMC5290793 DOI: 10.4103/2249-4863.197294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cocaine is a popular recreational drug in the United States, and up to 70% of the seized cocaine contains levamisole which is an antihelminthic that can cause cutaneous vasculitis with necrosis and positive antineutrophil cytoplasmic antibodies (ANCAs). Here, we report a unique case of recurrent cocaine-induced vasculitis in a patient who smokes cocaine for more than 20 years. A 38-year-old woman complained of painful erythematous rash in her right arm and right thigh which appeared some hours after smoking cocaine. Physical examination revealed tender, erythematous base, retiform purpura with necrosis and bullae. Serological test showed high atypical perinuclear ANCA titer of 1:320 and antimyeloperoxidase antibody level of 20.4 U/mL. Cocaine-induced vasculitis should be one of the differential diagnoses in cocaine abusers who present with painful rash and areas of necrosis. Early diagnosis is important since it is an emerging public health concern.
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Affiliation(s)
- Thein Swe
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA
| | - Mona Pervil-Ulysse
- Division of Rheumatology, Interfaith Medical Center, Brooklyn, New York, USA
| | - Aam A Baqui
- Department of Pathology, Interfaith Medical Center, Brooklyn, New York, USA
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