R J Green1, Q Gardiner1, K Vinod2, R Oparka3, P D Ross1. 1. Department of ENT, Ninewells Hospital and Medical School, Dundee, Scotland, UK. 2. Department of Rheumatology, Ninewells Hospital and Medical School, Dundee, Scotland, UK. 3. Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Abstract
BACKGROUND: Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS: A 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. RESULTS: Nine 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. CONCLUSION: As 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.
BACKGROUND:Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS: A 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. RESULTS: Nine 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. CONCLUSION: As 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.
Entities:
Keywords:
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Cocaine; Deformities; Nasal Obstruction; Nose
Authors: Letizia Nitro; Carlotta Pipolo; Gian Luca Fadda; Giovanni Felisati; Alberto Maria Saibene; Fabiana Allevi; Mario Borgione; Giovanni Cavallo Journal: Eur Arch Otorhinolaryngol Date: 2022-02-09 Impact factor: 3.236