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Dar T, Abou-Abdallah M, Michaels J, Talwar R. Cocaine-associated Eustachian tube stenosis causing chronic 'glue ear': a rare cocaine-induced destructive lesion. J Laryngol Otol 2024; 138:699-702. [PMID: 38326948 DOI: 10.1017/s0022215124000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate - termed cocaine-induced midline destructive lesions. CASE REPORT A 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use. CONCLUSION This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available.
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Affiliation(s)
- Talib Dar
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
| | | | - Joshua Michaels
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
| | - Rishi Talwar
- ENT Department, Luton and Dunstable University Hospital, Luton, UK
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Aseem F, Lin V, Gilbert AL, Rivadeneira AC, Jennette JC, Bouldin TW, Khoshbakht F, Lee YZ, Chamberlin K, Gelinne A, Mehrabyan AC, Javed B, Dujmovic Basuroski I, Diaz MM. ANCA-associated vasculitis presenting with isolated neurological manifestations in a patient with cocaine abuse: a case report and literature review. Clin Rheumatol 2024; 43:1401-1407. [PMID: 38416306 DOI: 10.1007/s10067-024-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare conditions predominantly affecting small vessels of skin, musculoskeletal, pulmonary, renal, and rarely central and peripheral nervous systems. Isolated neurological manifestations of AAV are uncommon and challenging to diagnose. Cocaine has been reported as a potential trigger for the development of AAV. There are only a few case reports of isolated neurological involvement in cocaine-induced AAV with poorly characterized histopathological features. We present a unique case of AAV with isolated neurological manifestations presenting with multiple cranial neuropathies, leptomeningeal enhancement on imaging and histopathologic evidence of small-vessel vasculitis in the leptomeninges and brain and extensive dural fibrosis in a patient with cocaine abuse. The patient's progressive neurological deficits were controlled after starting immunosuppression with rituximab and prednisone. We also reviewed the literature to provide the diagnostic overview of AAV and evaluate intervention options. To our knowledge, this is the first case of AAV with isolated neurological manifestations and histopathologic evidence of small-vessel vasculitis in a patient with cocaine abuse. Patients with multiple cranial neuropathies and meningeal involvement should be screened for AAV, especially if they have a history of cocaine abuse.
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Affiliation(s)
- Fazila Aseem
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Victor Lin
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Abigail L Gilbert
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Alfredo C Rivadeneira
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Freshta Khoshbakht
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Anahit C Mehrabyan
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Bushra Javed
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Irena Dujmovic Basuroski
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Monica M Diaz
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA.
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DI COSOLA M, SEMBRONIO S, DIOGUARDI M, ROBIONY M, DIAZ-FLORES GARCIA V, PUCCI R, DELLA MONACA M, LO MUZIO L, SPIRITO F, BRAUNER E, PIACENTILE KA, NOCINI R, COPELLI C. The clinical manifestations of cocaine-induced midline destructive lesion: a real challenge for maxillo-facial surgeons, mapping evidence review. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05502-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ortega-Hidalgo BD, Monge K, Pérez V, Villanueva-Vilchis MDC, Gaitán-Cepeda LA. Non-neoplasic and non-syndromic palatal perforations. Presentation of 5 cases and systematic review of the literature. J Clin Exp Dent 2021; 13:e961-e968. [PMID: 34603627 PMCID: PMC8464392 DOI: 10.4317/jced.58714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Palatal perforations not associated with syndromes or neoplasms are rare lesions whose frequency has increased recently. However, their clinical and demographic characteristics have not been fully described. Therefore, this report aimed to establish the demographic and clinical characteristics of patients with non-syndromic and non-neoplastic palatal perforations. MATERIAL AND METHODS The file of an oral medicine teaching clinic from January 2004 to December 2018 was reviewed to identify and isolate all cases with a diagnosis of palatal perforation. Cases with a diagnosis of palatal perforation related to congenital alteration, syndrome, or neoplasia were excluded. Age, sex, medical history, and diagnosis were obtained from the clinical history. In addition, a systematic review of the literature was performed using a PICO strategy. MEDLINE electronic databases from January 1990 to December 2018 were systematically reviewed using the combination of keywords with Boolean terms "OR" (palatal perforation, destruction of the palate) and "AND" (drugs, cocaine, mycosis, syphilis, mucormycosis, tuberculosis, trauma). The PRISMA guide was used to identify the different results of the literature search and article selection process. Case reports and case series were included. RESULTS Five cases of non-syndromic, non-neoplastic palatal perforations were identified. All cases were male with a mean age of 42 years. Two cases were related to cocaine use, 2 cases were caused by mucormycosis, and one case by trauma. As for the systematic literature review, 51 non-neoplastic and non-syndromic cases were collected. The cases showed a male predominance, with a mean age of 41 years. The most frequent etiology was chronic cocaine use followed by mucormycosis. CONCLUSIONS Since cocaine use and type II Diabetes Mellitus, risk factors related to non-syndromic and non-neoplastic palatal perforations, have shown a worldwide increase, the clinician should be alert to make an early diagnosis and initiate appropriate treatment. Key words:Palatal perforation, cocaine-induced, mucormycosis, mycotic infection, drug users.
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Affiliation(s)
| | - Karen Monge
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | - Vania Pérez
- Dental student, Dental School, University of Sonora, Hermosillo, Sonora, México
| | | | - Luis-Alberto Gaitán-Cepeda
- Full time Professor of Department of Oral Pathology and Oral Medicine, Graduate and Research Division, Dental School, National Autonomous University of Mexico. Mexico City, Mexico
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Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157831. [PMID: 34360121 PMCID: PMC8345435 DOI: 10.3390/ijerph18157831] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
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.
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Cocaine-Induced Midline Destructive Lesions: A Real Challenge in Oral Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063219. [PMID: 33804629 PMCID: PMC8003646 DOI: 10.3390/ijerph18063219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/05/2022]
Abstract
Cocaine abuse is associated with severe local effects on mucosal and osteocartilaginous structures, with a centrifugal spreading pattern from the nose, a condition known as cocaine-induced midline destructive lesions (CIMDL). When the soft or hard palate is affected, a perforation may occur, with subsequent oro-nasal reflux and hypernasal speech. Both diagnosis and therapy (surgical or prosthetic) constitute a serious challenge for the physician. The cases of three patients affected by cocaine-induced palatal perforation and treated with a palatal obturator at San Raffaele Dentistry department between 2016 and 2019 are presented. In addition, the literature was reviewed in search of papers reporting the therapeutic management in patients affected by cocaine-induced palatal perforation. All the patients in our sample suffered from oro-nasal reflux and hypernasal speech, and reported a significant impact on interpersonal relationships. The results at the delivery of the obturator were satisfactory, but the duration of such results was limited in two cases, as the progression of the disease necessitated continuous modifications of the product, with a consequent increase in costs and a reduction in patient satisfaction. In conclusion, the therapy for palatal defects in CIMDL includes both reconstructive surgery and prosthetic obturators, the latter being the only possibility in the event of active disease. It successfully relieves symptoms, but the long-term efficacy is strongly related to the level of disease activity.
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Localized Granulomatous with Polyangiitis (GPA): Varied Clinical Presentations and Update on Treatment. Curr Allergy Asthma Rep 2020; 20:56. [PMID: 32648055 DOI: 10.1007/s11882-020-00953-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Granulomatosis with polyangiitis is a primary systemic vasculitis commonly described with the typical triad of upper airway, lung, and kidney involvement. Upper and lower airway involvement is characteristic in patients with granulomatosis with polyangiitis and can sometimes represent the initial or in some instances the sole manifestation. The objective of this review is to summarize the various clinical manifestations of localized disease in GPA and their treatment. RECENT FINDINGS Sinonasal disease is seen in up to 90% of patients. Otologic and ocular involvement is also commonly seen. Laryngeal and tracheal disease although less common is associated with significant morbidity and can be therapeutically challenging. Clinicians need to be aware of these localized GPA manifestations as they may be presenting disease features in the absence of other systemic findings. Treatment of localized GPA involves both immunosuppressive and surgical interventions for specific manifestations. Collaboration between specialists including rheumatologists, otolaryngologists, and ophthalmologists is often crucial to ensure optimal outcomes for patients. This is a narrative review that provides a comprehensive overview of localized granulomatosis with polyangiitis and current treatment options.
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Bacciu A, Ghirelli M, Ingegnoli A, Bozzetti F. Cocaine-Induced Midline Destructive Lesions Associated With Erosion of the Eustachian Tube. JAMA Otolaryngol Head Neck Surg 2019; 144:846-848. [PMID: 30098140 DOI: 10.1001/jamaoto.2018.1387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrea Bacciu
- Unit of Otolaryngology and Otoneurosurgery, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Michael Ghirelli
- Unit of Otolaryngology and Otoneurosurgery, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Anna Ingegnoli
- Unit of Radiology, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
| | - Francesca Bozzetti
- Unit of Radiology, Department of Medicine and Surgery, University-Hospital of Parma, Parma, Italy
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Abstract
The sinonasal tract is frequently affected by nonneoplastic inflammatory diseases. Inflammatory lesions of the sinonasal tract can be divided into 3 main categories: chronic rhinosinusitis, which encompasses a heterogeneous group of entities, all of which result in mucosal inflammation with or without polyps-eosinophils; infectious diseases; and autoimmune diseases and vasculitides, which can result in midline necrosis and facial deformities. This article reviews the common inflammatory lesions of the sinonasal tract with emphasis on infectious diseases, vasculitis, iatrogenic, and diseases of unknown cause. Many of these lesions can result in midline destruction and result in facial deformity.
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Affiliation(s)
- Kathleen T Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA.
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104, USA
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10
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Abstract
CONTEXT A number of entities may result in necrosis in the sinonasal tract and lead to significant morbidity and mortality. These include infections, necrotizing vasculitis, neoplastic processes, and drug dependency. This review will concentrate on the differential diagnosis of sinonasal necrotizing lesions. OBJECTIVE To review the differential diagnoses of necrotizing destructive lesions of the sinonasal tract. DATA SOURCES The current literature was reviewed to provide updated information regarding the differential diagnosis of sinonasal necrotizing lesions, including infectious disease processes; antineutrophilic cytoplasmic antibody-associated vasculitides; neoplastic processes, particularly natural killer/T-cell lymphomas; and drug abuse. CONCLUSIONS The differential diagnosis of necrotizing sinonasal lesions is broad, with often overlapping diagnostic features that lead to diagnostic challenges. Ancillary tests such as special stains and immunohistochemical studies can offer significant assistance.
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Affiliation(s)
- Kathleen T Montone
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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Nolan AL, Jen KY. Pathologic manifestations of levamisole-adulterated cocaine exposure. Diagn Pathol 2015; 10:48. [PMID: 25943359 PMCID: PMC4419488 DOI: 10.1186/s13000-015-0279-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 04/16/2015] [Indexed: 11/30/2022] Open
Abstract
ᅟ Rheumatic manifestations of cocaine have been well described, but more recently, a dramatic increase in the levamisole-adulterated cocaine supply in the United States has disclosed unique pathologic consequences that are distinct from pure cocaine use. Most notably, patients show skin lesions and renal dysfunction in the setting of extremely high perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). Unexpectedly, antibodies to myeloperoxidase, the typical target of p-ANCA, are relatively low if at all present. This discrepancy is due to the fact that p-ANCA seen in association with levamisole-adulterated cocaine exposure is often directed against atypical p-ANCA-associated antigens within the neutrophil granules such as human neutrophil elastase, lactoferrin, and cathepsin G. Biopsies of the skin lesions reveal leukocytoclastic vasculitis often involving both superficial and deep dermal vessels. Renal injury most typically manifests as crescentic and necrotizing pauci-immune glomerulonephritis. In this review, the manifestations of levamisole-adulterated cocaine-induced vasculitis are discussed with an emphasis on the typical histomorphologic findings seen on biopsy. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1764738711370019.
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Affiliation(s)
- Amber L Nolan
- Department of Pathology, University of California San Francisco, 513 Parnassus Avenue, Box 0102, San Francisco, CA, 94143, USA.
| | - Kuang-Yu Jen
- Department of Pathology, University of California San Francisco, 513 Parnassus Avenue, Box 0102, San Francisco, CA, 94143, USA.
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Crovetto-Martínez R, Aguirre-Urizar JM, Orte-Aldea C, Araluce-Iturbe I, Whyte-Orozco J, Crovetto-De la Torre MA. Mucocutaneous leishmaniasis must be included in the differential diagnosis of midline destructive disease: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e20-6. [PMID: 25442251 DOI: 10.1016/j.oooo.2014.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/18/2014] [Accepted: 09/09/2014] [Indexed: 01/05/2023]
Abstract
Midline destructive lesions have multiple possible etiologies, which can be grouped into neoplastic, infectious, or vasculitis-associated. The purpose of these case reports and literature review was to highlight the need to include mucocutaneous leishmaniasis in the diagnosis of midfacial lesions in any patient who has lived in Leishmania-endemic areas because this entity meets all of the clinical criteria to be considered a form of midline destructive lesion. We present two cases of mucocutaneous leishmaniasis that occurred in a Bolivian male immigrant and a European male traveler to Panama, in whom lesions were misdiagnosed as different midline destructive lesions with different causes (Wegener, vasculitis, and natural killer or T-cell lymphoma [NKTL]). The conclusion of our work is that all patients with midline destructive lesions should undergo histologic and molecular studies to be evaluated for mucosal leishmaniasis, particularly patients whose clinical history suggests this possibility. In cases of uvular involvement, biopsy of this region might be a possible alternative to nasal biopsy.
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Affiliation(s)
- R Crovetto-Martínez
- Department of Stomatology II, University of the Basque Country / EHU, Spain.
| | - J M Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country / EHU, Spain
| | - C Orte-Aldea
- Department of Otorhinolaryngology, Miguel Servet Hospital, Zaragoza, Spain
| | - I Araluce-Iturbe
- Department of Otorhinolaryngology, Basurto University Hospital (UPV/EHU), Bilbao, Vizcaya, Spain
| | - J Whyte-Orozco
- Department of Anatomy and Histology, University of Zaragoza, Spain
| | - M A Crovetto-De la Torre
- Department of Otorhinolaryngology, Basurto University Hospital (UPV/EHU), Bilbao, Vizcaya, Spain
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