Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user

COVID-19 infection and treatment-resistant cocaine-induced pyoderma gangrenosum: A case report

Introduction

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of non-infectious etiology. Cocaine-induced PG (CIPG) is a documented clinical variant.

Case presentation

We report an exceptional case of cocaine-induced PG flare unresponsive to conventional treatment in the context of positive COVID status. A 41year-old male with past medical history of recent COVID infection, pyoderma gangrenosum and chronic cocaine abuse presented with acutely worsening multifocal ulcerations covering multiple limbs approximately 30% body surface area (BSA) one day after cocaine use. After hospitalization for ten days with no improvement in cutaneous symptoms, he was transferred to a burn center for disease control with biologics.

Discussion

The previous temporal relationship between disease outbreak and cocaine consumption and improvement after its discontinuation no longer remained in the setting of COVID positive status. This is the first case in literature of extensive and treatment-refractory PG in a COVID-positive patient with recent cocaine use.

Conclusion

This case highlights the importance of further investigation on the connection between COVID infection and PG and the need for establishing treatment guidelines for PG.

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This is the first recorded case of treatment-refractory cocaine-induced pyoderma gangrenosum with active COVID infection.

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Further studies on the relationship between active COVID infection and Pyoderma Gangrenosum exacerbations are warranted.

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Multidisciplinary care is needed in tailoring management to persistent pyoderma gangrenosum in patients with COVID infection.

Pyoderma gangrenosum associated to the use of cocaine/levamisole. Series of three cases and literature review

Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.

Multifocal cocaine-induced pyoderma gangrenosum: A report of two cases and review of literature

Pyoderma gangrenosum is often associated with a systemic disease. Cocaine-induced pyoderma gangrenosum, most probably caused by levamisole, has been described recently and typically presents as multiple, large cribriform ulcers. Peri-nuclear antineutrophil cytoplasmic antibody is the most common serological finding. A strong counseling for cocaine cessation, combined with wound care and immunosuppressive therapy, is the mainstay of treatment. We present two cases of cocaine-induced pyoderma gangrenosum and correlate their findings with the typical clinical, histological and serological presentation.

Nasoseptal Perforation: from Etiology to Treatment

PURPOSE OF REVIEW

Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment.

RECENT FINDINGS

NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.