Massive Apoptosis Erodes Nasal Mucosa of Cocaine Abusers

Trimarchi, Matteo; Miluzio, Annarita; Nicolai, Piero; Morassi, Maria Laura; Bussi, Mario; Marchisio, Pier Carlo

doi:10.1177/194589240602000207

Cited by 36 publications

(37 citation statements)

References 16 publications

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“…13 Magnetic resonance imaging represents the most useful first-line choice for radiological evaluation of patients with CIMDL. 23,24 Magnetic resonance imaging can detect areas of abnormal nasal or paranasal mucosa. 11,25 In cocaine abusers, significant enlargement of the palatine or pharyngeal tonsils has been associated with small fluid collections within lymphatic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…However, differentiation of CIMDL from limited forms of GPA can be more difficult. [23][24][25] Histopathological features shared between CIMDL and GPA-and thus not allowing for their differentiation-include mixed inflammatory infiltrates, microabscesses in vascular walls, perivenulitis, vascular microthrombotic changes, leukocytoclastic vasculitis, and fibrinoid necrosis. 23 Only extravascular changes such as stromal granulomas with giant cells, microabscesses, and deeply located necrosis are features that seem to be pathognomonic for GPA.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, cocaine seems to induce apoptosis of the respiratory epithelial cells and perhaps of the inflammatory cells in the nasal passages. 24 The apoptosis-inducing effects of cocaine are dose and time dependent. 24 In summary, CIMDLs seem to be the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of patients predisposed to produce ANCA, particularly those reacting with HNE.…”

Section: Discussionmentioning

confidence: 99%

“…24 The apoptosis-inducing effects of cocaine are dose and time dependent. 24 In summary, CIMDLs seem to be the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of patients predisposed to produce ANCA, particularly those reacting with HNE. 22 The management of cocaine abusers represents a real clinical challenge.…”

Section: Discussionmentioning

confidence: 99%

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Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

Brembilla¹,

Lanterna²,

Risso³

et al. 2015

SPI

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With the increasingly widespread illicit use of cocaine, a broad spectrum of clinical pathologies related to this form of drug abuse is emerging. The most frequently used method of administration of powdered cocaine is intranasal inhalation, or “snorting.” Consequently, adverse effects of cocaine on the nasal tract are common. Habitual nasal insufflations of cocaine can cause mucosal lesions. If cocaine use becomes chronic and compulsive, progressive damage of the mucosa and perichondrium leads to ischemic necrosis of the septal cartilage and perforation of the nasal septum. Occasionally, cocaine-induced lesions cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate and can mimic other diseases such as tumors, infections, and immunological diseases. In the literature currently available, involvement of the craniovertebral junction in the cocaine-induced midline destructive lesions (CIMDLs) has never been reported. The present case concerns a 44-year-old man who presented with long-standing symptoms including nasal obstruction, epistaxis, dysphagia, nasal reflux, and severe neck pain. A diagnosis of CIMDL was made in light of the patient’s history and the findings on physical and endoscopic examinations, imaging studies, and laboratory testing. Involvement of the craniovertebral junction in the destructive process was evident. For neurosurgical treatment, the authors considered the high grade of atlantoaxial instability, the poorly understood cocaine-induced lesions of the spine and their potential evolution overtime, as well as cocaine abusers’ poor compliance. The patient underwent posterior craniovertebral fixation. Understanding, classifying, and treating cocaine-induced lesions involving the craniovertebral junction are a challenge.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

Brembilla¹,

Lanterna²,

Risso³

et al. 2015

SPI

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“…In non-professional phagocytes, e.g., epithelial cells 13 , cardiocytes 14 , and cortical neurons 15 , cocaine induces apoptosis. Dey and Snow found that embryonic locus coeruleus neurons undergo apoptosis after cocaine exposure 16 .…”

Section: Rheumatologymentioning

confidence: 99%

Systemic Lupus Erythematosus in 6 Male Cocaine Users at Bellevue Hospital: Table 1.

2009

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International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

Wise

Lin

Toskala

et al. 2018

Int Forum Allergy Rhinol

322

453

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This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

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Massive Apoptosis Erodes Nasal Mucosa of Cocaine Abusers

Cited by 36 publications

References 16 publications

Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

Craniovertebral junction instability as an extension of cocaine-induced midline destructive lesions: case report

Systemic Lupus Erythematosus in 6 Male Cocaine Users at Bellevue Hospital: Table 1.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

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