A case series and literature review on patients with rhinological complications secondary to the use of cocaine and levamisole

Abstract

BackgroundLevamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.MethodsA 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.ResultsNine 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.ConclusionAs 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.

Distribution of cocaine-induced midline destructive lesions: systematic review and classification

“…Alexandrakis et al [17] Fibrosis with chronic inflammation and occasional Russell bodies (n = 2); dense infiltrate of chronic inflammatory cells (lymphocytes and plasma cells), periductal fibrosis (n = 1) Armengot et al [18] Nonspecific (n = 1); cocaine-related vasculitis (n = 1) Green et al [20] Nonspecific inflammation (n = 6) Lanzillotta et al [21] Chronic inflammation, focally erosive and squamous metaplasia. No microabscesses within the vascular walls, vasculitis, or granulomas were detected.…”

Posterior Ischemic Optic Neuropathy in the Setting of Cocaine-Induced Orbital and Sinonasal Inflammation

“…1 In addition, cocaine is commonly adultered with other agents, such as amphetamine or levimasole, which further contribute to sinodestruction and vasculitis. 2,3 Although detrimental effects from cocaine are most commonly seen in the nasal cavity and sinuses, cocaine can also cause various ophthalmic complications, ranging from corneal ulcers because of topical administration, 4 to preseptal and orbital cellulitis, panophthalmitis, 5,6 orbital apex syndrome and optic neuropathy. 1,2,[7][8][9] This is the first documented case of cocaine-induced PION.…”

“…To the authors' knowledge, there are fewer than 10 case reports of pediatric DF with orbital involvement in the literature. [3][4][5][6] The majority of reported DF cases involving the orbit have been treated primarily with surgical excision. However, DF treated with surgery has been shown to be followed by high recurrence rates, despite partial or complete excision.…”

Levamisole-Adulterated Cocaine-Induced Mucous Membrane Pemphigoid: Case Reports and Literature Review

“…Sinusitis and destruction of sinonasal structures are often described in patients who snort cocaine. 4 Necrosis of sinus mucosa, nasal and palatal perforation, and midline sinonasal destruction can be seen. In rare cases, disease can extend to the basal skull, pharyngeal region, and oral cavity or to the orbit.…”