Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Abstract

The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists.

Granulomatosis with polyangiitis or its mimic? A case report

“…2,8 Some reports of CIMDL have described centrifugal expansion starting from the nasal septum and extending to the inferior and middle turbinates and the hard palate. 8,12 This pattern was followed up in our patient by serial ENT examinations and CT scans. According to the four-grade destruction location-based classification proposed by Nitro et al, 13 our case corresponds to grade 3 CIMDL.…”

Midline destructive lesions: A diagnostic challenge

“…In many cases, in spite of complete workup, the cause cannot be discernible. 6 Nasal type T-NK cells lymphoma is not a common type of Epstein-Barr virus (EBV) associated lymphoma but commonly presents as MDLs. In any MDLs, histopathological examination and ancillary tests are pivotal in establishing the diagnosis.…”

“…The other diseases which can present as MDLs are cocaine-induced midline lesions, IgG4-related disease, leishmaniasis and fungal infections. 11 Cocaine-induced midline lesion (CIML) can show extensive necrosis and antineutrophil cytoplasmic antibodies on serology mimicking WG, but multinucleated giant cells, fibrinoid necrosis, and perivascular inflammatory infiltrate are not seen in CIML. 12 A rare manifestation of cutaneous leishmaniasis can be MLD, especially in the endemic region.…”

Efficacy of a Non-addictive Nasal Irrigation Based on Sea Salt Enriched with Natural Enzymes among Patients with Sinusitis: An In Vivo, Randomized, Controlled Trial

“…Topical nasal rinses take advantage of this secretory lining in multiple ways. First, nasal rinses physically disrupt the viscous surface layer, removing the mucus and its associated particulate matter [16], [17], [18], [19], [20], [21], [22]. In addition, the presence of nasal saline is hypothesized to function by thinning mucous, improving mucociliary clearance, decreasing edema, and reducing antigen load in the nasal and sinus cavities.…”

“…In addition, the presence of nasal saline is hypothesized to function by thinning mucous, improving mucociliary clearance, decreasing edema, and reducing antigen load in the nasal and sinus cavities. Although its use in CRS is nearly universal, significant variety exists with regard to delivery volume, delivery pressure, frequency of use, duration of use, composition, and hygiene recommendations [22], [23], [24], [25], [26], [27], [28]. There were several studies assessing QOL in CRS patients.…”