Cocaine-Induced Midline Destructive Lesions

Trimarchi, Matteo; Gregorini, Gina; Facchetti, Fabio; Morassi, Maria Laura; Manfredini, Cinzia; Maroldi, Roberto; Nicolai, Piero; Russell, Kimberly A.; McDonald, Thomas J.; Specks, Ulrich

doi:10.1097/00005792-200111000-00005

Cited by 144 publications

(82 citation statements)

References 65 publications

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“…16 The patient's history of cocaine insufflation was sufficient to arrive at a final diagnosis of a cocaine-induced midline destructive lesion (CIMDL). [15][16][17] This case underscores the importance of obtaining a thorough (past and present) and private social history (drugs, sexual history, etc.). It highlights the comparable clinical features of various MDLs.…”

Section: Diagnosis and Managementmentioning

confidence: 90%

“…It is reported that less than 4.5% of patients present with MDL. 14,15 It has been observed that CIMDL presents with characteristic centrifugal bone destruction: nasal septum (75%), turbinates (63%), lateral nasal wall (31%), nasal floor (<20%), and soft palate (<1%). This centrifugal pattern of destruction is not observed in patients with polyangitides.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

“…This centrifugal pattern of destruction is not observed in patients with polyangitides. 15 In addition, what seems to distinguish patients with CIMDL from those without it is the presence of antineutrophil cytoplasmic antibodies (ANCAs) in CIMDL. 14 The predominant ANCA types in CIMDL are HNE-ANCA and PR3-ANCA (c-ANCA).…”

Section: Diagnosis and Managementmentioning

confidence: 99%

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Clinical Pathologic Conference Case 2: Palatal Perforation

Dovigi¹,

Natarajan

2015

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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Section: Diagnosis and Managementmentioning

confidence: 90%

Section: Diagnosis and Managementmentioning

confidence: 99%

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Clinical Pathologic Conference Case 2: Palatal Perforation

Dovigi¹,

Natarajan

2015

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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“…Progressive damage of the mucosa and perichondrium associated with chronic cocaine use leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. The mucosal damage induced by cocaine is multifactorial, with the vasoconstrictive effect of the drug thought to be the most important factor 5–7. However, the irritant effect of the adulterants of the drug, the traumatic effect on the mucosa caused by cocaine crystals insufflated at high velocity, and the recurrent nasal infections all seem to contribute to chronic tissue destruction 6,8.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

“…However, the irritant effect of the adulterants of the drug, the traumatic effect on the mucosa caused by cocaine crystals insufflated at high velocity, and the recurrent nasal infections all seem to contribute to chronic tissue destruction 6,8. Cocaine-induced lesions occasionally cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases associated with necrotizing midfacial lesions 7. Progressive nasal obstruction, epistaxis with crusting, and ulceration of the nasal mucosa with or without septal perforation are also characteristic manifestations of nasal involvement by GPA.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

Cocaine-induced Vasculitis

Berman¹,

Paran²,

Elkayam³

2016

Rambam Maimonides Med J

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The use of cocaine continues to grow worldwide. One of the possible side-effects of cocaine is vasculitis. Two distinct vasculitic syndromes have been described due to cocaine. One is cocaine-induced midline destructive lesion, secondary to a direct vasoconstrictor effect of cocaine, inducing ischemic necrosis of the septal cartilage and perforation of the nasal septum, mimicking findings of granulomatosis with polyangiitis in the upper airways. The other is ANCA-associated vasculitis, attributed to the levamisole component that contaminates about 70% of the cocaine. This type of vasculitis may be myeloperoxidase (MPO) and proteinase 3 (PR3) positive, and its main manifestations are typical cutaneous findings, arthralgia, otolaryngologic involvement, and agranulocytosis. A high degree of suspicion and awareness is needed in order properly to diagnose and treat these patients.

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Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube

Bacciu

Ghirelli

Ingegnoli

et al. 2018

JAMA Otolaryngol Head Neck Surg

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age of visits in which imaging was ordered was low, ranging from an estimated (SE) 1.4% (1.5%) in 2005-2006 to 5.8% (2.5%) in 2010-2012, although these estimates had large SEs. Primary care physicians had the lowest adherence to guidelines in 2005-2006 (43.4%), but adherence significantly improved in 2013-2015 (79.5%), reaching rates similar to those of otolaryngologists and neurologists (Figure).Discussion | The prevalence of ambulatory care visits for BPPV increased over time, which is likely a result, in part, of increased practitioner awareness and screening for BPPV. Adherence to guidelines by specialists was relatively high during the period examined, while adherence to guidelines by primary care physicians improved. Despite this improvement, antivertigo or antiemetic medications were still prescribed in 20.5% of primary care visits in 2013-2015.Although this analysis was limited by its reliance on the ICD-9-CM code for diagnosis and physician recommendations that potentially could be for other problems noted during the visit, similar analyses have been used to evaluate adherence to clinical practice guidelines. 6 According to guidelines published by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, physicians should provide the appropriate particle repositioning maneuver or refer the patient to a trained health care professional rather than recommend imaging or medication management. 2,3 Because primary care physicians are the likely entry point for most patients with BPPV, their understanding of and adherence to the clinical practice guidelines is important. Our results suggest that opportunities remain to improve the value of ambulatory care for patients with BPPV by limiting inappropriate medication prescription.

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Cocaine-Induced Midline Destructive Lesions

Cited by 144 publications

References 65 publications

Clinical Pathologic Conference Case 2: Palatal Perforation

Clinical Pathologic Conference Case 2: Palatal Perforation

Cocaine-induced Vasculitis

Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube

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