Four-Extremity Gangrene Associated With Crack Cocaine Abuse

Dhawan, Saurabh S.; Wang, Benjamin W. E.

doi:10.1016/j.annemergmed.2006.08.001

Cited by 24 publications

(11 citation statements)

References 12 publications

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“…Secondary systemic manifestations include coronary vasospasm, acute myocardial ischaemia, thrombosis, ischaemic stroke and intracranial haemorrhages, as well as necrotizing enterocolitis, renal infarction and splenic infarction due to splanchnic vasospasm. 3…”

Section: Pathogenymentioning

confidence: 99%

“…Systemic manifestations include coronary vasospasm, acute myocardial ischaemia, thrombosis, ischaemic stroke with or without cognitive impairment, and intracranial haemorrhages, as well as necrotizing enterocolitis, renal infarction and splenic infarction due to splanchnic vasospasm. 3 In the skin, Raynaud's phenomenon, distal ulcers, digital gangrene have been reported. In fact, cocaine abuse may mimic Buerger's disease as it causes peripheral arterial disease.…”

Section: Cutaneous Manifestations Of Cocaine-induced Vascular Injurymentioning

confidence: 99%

See 1 more Smart Citation

Mucocutaneous manifestations of cocaine abuse: a review

Moreno‐Artero

Querol-Cisneros

Rodríguez‐Garijo

et al. 2018

Acad Dermatol Venereol

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Cocaine is an alkaloid extracted from the leaves of the Erythroxylum coca plant that emerged in the 1970s as a fashionable drug among members of certain social backgrounds. Cocaine abuse is a problem of current interest, which is mostly hidden and underdiagnosed, but dramatically widespread among all socio-economic strata, and with an incidence which is increasing at an alarming rate. There are 1.5 million cocaine consumers in the USA. In Spain, the prevalence of consumption among the population between 15 and 65 years old is higher, reaching 3.1%. Because of this, it seems important to understand and recognize all the mucocutaneous manifestations of cocaine abuse which have been reported in the literature to clarify and to help dermatologists in their daily practice. In this article, we describe the principal mucocutaneous manifestations of cocaine abuse and we review isolated case reports which have been published in the literature. Because the dermatologist may deal with an unknown problem as well as with an already well-known history of cocaine abuse, it seems logical to separate the mucocutaneous manifestations into those which are frequent and highly suggestive, such as those caused by vascular injury, damage to mucosal membranes, infectious diseases or neutrophilic dermatosis, especially when suffered by young people and in consonance with other systemic manifestations and, those which have been reported in the literature as isolated case reports. We also summarize the main aspects of its pathogeny, principal pharmacodynamic and pharmacokinetic characteristics, and diagnostic tools.

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Section: Pathogenymentioning

confidence: 99%

Section: Cutaneous Manifestations Of Cocaine-induced Vascular Injurymentioning

confidence: 99%

Mucocutaneous manifestations of cocaine abuse: a review

Moreno‐Artero

Querol-Cisneros

Rodríguez‐Garijo

et al. 2018

Acad Dermatol Venereol

View full text Add to dashboard Cite

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“…Drugs of abuse, for example, associated with rhabdomyolysis due to compression, overuse, or direct myotoxicity, may also cause compartment syndrome [62,63]. Similarly, patients with crotaline venom-induced rhabdomyolysis may go on to develop compartment syndrome.…”

Section: What Is the Mechanism By Which Xenobiotics Cause Compartmentmentioning

confidence: 99%

Case Files of the Medical Toxicology Fellowship at Drexel University

Vearrier

Curtis

2011

J. Med. Toxicol.

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A 28-year-old female was brought to the emergency department (ED) by her roommate after a suicide attempt, in which the patient took 29 capsules of an over-the-counter (OTC) sleep aid containing 50 mg of diphenhydramine (DPH) per capsule, for a total of 1450 mg, and consumed 100 ml of vodka. Her weight was 67 kg, yielding a dose of 22 mg/kg DPH. When a roommate arrived home from work several hours later, he noticed that the patient was walking aimlessly through the house and that "she was out of it." The patient subsequently informed the roommate of her suicide attempt, at which point he brought her by car to our ED. According to the patient, the ingestion occurred 9 h prior to arrival.In the ED, the patient complained of bilateral tingling and numbness in her legs and feet that had started within the last 4 h. She had a subjective sensation of inability to control the muscles in her legs and leg weakness. The patient denied any history of leg trauma, recent strenuous physical activity, or recent prolonged inactivity. Her medical history was significant for cervical dysplasia status post surgical excision and major depressive disorder. The patient denied taking any other prescribed or OTC medications, which her roommate corroborated.Physical examination revealed a young, disheveled female with normal body habitus. Initial vital signs included a temperature of 36.4°C, heart rate 123 beats/ min, respiratory rate 18 breaths/min, blood pressure 112/ 83 mm Hg, and pulse oximetry of 98% on room air. Pupils were 6 mm bilaterally and sluggishly reactive to light. Extraocular movements were intact. The mucous membranes of the oropharynx were dry. Cardiac examination was significant for a regular tachycardia, while the pulmonary examination was normal. Abdominal examination was significant for bowel sounds being present but decreased. The patient was alert and oriented to self and place, but not to time. She was able to answer simple questions, but was slow to respond. Strength, sensation, and deep tendon reflexes were normal. No ataxia or tremor was present. Extremity examination was significant for mottled skin color on the anterior legs bilaterally. Dorsalis pedis and posterior tibialis pulses were normal, as was sensation, strength, and capillary refill throughout the bilateral lower extremities. What is the Pharmacology of DPH?DPH is a first-generation H 1 antihistamine. It belongs to the ethanolamine subclass of antihistamines along with carbinoxamine, clemastine, dimenhydrinate, and doxylamine. Histamine receptors are categorized into four subtypes This case report was presented in poster form at the EAPCCT conference in 2009 in Stockholm, Sweden.

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“…Although none of the patients had critical ischemia, thickening of the walls of peripheral arteries in the lower limbs may be related to arteritis secondary to crack use. 10 Critical ischemia is defined as absent pulses combined with claudication, pain at rest or trophic ulcers. Balbir-Gurman (2001) reported a case of a young man who exhibited hyperplasia of the smooth musculature of small arterial vessels with necrosis of the fingers after the Raynaud phenomenon, induced by crack use.…”

Section: 18mentioning

confidence: 99%

“…In turn, there is a report of vascular disease secondary to vasospasm related to chronic crack use, which resulted in gangrene of upper and lower limbs requiring digital and above-knee amputations. 10 Peripheral arterial occlusive disease (PAOD) is characterized by a reduction in blood flow to the limbs caused by an occlusive process involving the arterial beds. 11 In the majority of cases it is the result of an atherosclerotic process, but it can also have other etiologies, such as arterites, spasms, aneurysms or thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Perfil das alterações vasculares periféricas em dependentes de crack acompanhados em Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-AD)

et al. 2016

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Background: Consumption of crack is one of the major challenges in public health and taking this drug has direct effects on the health of those who use it. Objectives: To evaluate the profile of vascular abnormalities in patients receiving treatment for crack dependency at a Psychosocial Care Center for Alcohol and Drugs and to observe possible peripheral vascular effects. Methods: The study design is observational, descriptive and cross-sectional. An objective questionnaire was administered to the patients in the sample to collect data on demographic details; drug use profile; and concomitant diabetes mellitus, arterial hypertension and/or smoking; and physical and ultrasound examinations were conducted. Data were summarized and analyzed statistically with the chi-square test or Fisher' s exact test. Results: The mean age of the sample was 33.29 (±7.15) years, and 74% were male. Mean age at onset of drug use was 23.4 (±7.78) years and mean time since onset was 9.58 (±5.64) years. Mean consumption of crack rocks was 21.45 (±8.32) per day. The rate of abnormal lower limb pulses was higher among women. The prevalence of artery wall thickening in lower limbs was 94.8%. Time since starting to use crack exhibited a statistically significant association (p = 0.0096) with abnormalities in the spectral curve profiles of lower limb arteries. Conclusions: Crack users exhibit peripheral vascular disorders. Length of time since starting to use the drug had the greatest impact on this system, suggesting an association between crack use and reduced arterial flow.

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Four-Extremity Gangrene Associated With Crack Cocaine Abuse

Cited by 24 publications

References 12 publications

Mucocutaneous manifestations of cocaine abuse: a review

Mucocutaneous manifestations of cocaine abuse: a review

Case Files of the Medical Toxicology Fellowship at Drexel University

Perfil das alterações vasculares periféricas em dependentes de crack acompanhados em Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-AD)

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