Snorting the Clivus Away: an Extreme Case of Cocaine-induced Midline Destructive Lesion

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2016 Nov 1

PMID 27797859

Citations 10

Authors

Marco Molteni

Alberto Maria Saibene

Ketty Luciano

Alberto Maccari

Affiliations

Soon will be listed here.

Abstract

Cocaine is a drug with relevant socioeconomic and clinical implications, which is usually recreationally used for its stimulant effects. It is widely known that the habit of snorting cocaine is associated with a peculiar type of drug-induced chronic rhinitis, which leads to inflammation of the sinonasal mucosa, slowly progressing to a destruction of nasal, palatal and pharyngeal tissues. These characteristic lesions due to cocaine abuse are commonly called cocaine-induced midline destructive lesions (CIMDL). Diagnosis is not always straightforward, since various conditions, mainly vasculitis, might mimic this acquired condition. The extent of pharyngeal involvement varies, although often a prolonged abuse can trigger a progressive destruction of oral and nasal tissues, with development of infections and recurrent inflammation. Our article focuses on cocaine as a world health problem with important ear, nose and throat implications and discusses the difficulties in diagnosing and treating CIMDL, through a case report.

Citing Articles

Complete Clival Resorption and Pontine Pneumatosis Secondary to Severe Cocaine-Induced Midline Destructive Lesion: A Case Report.

Almansouri A, Tham A, Abobotain A, Almarwani M, Tewfik M, Sirhan D Neurosurg Pract. 2025; 5(1):e00076.

PMID: 39957861 PMC: 11783658. DOI: 10.1227/neuprac.0000000000000076.

Cocaine-induced destruction of the palate: a diagnostic and management challenge.

Maloney B, Hinchion K, Conlon N, Omer O, Pierse D Br Dent J. 2024; 237(6):465-471.

PMID: 39333814 PMC: 11436349. DOI: 10.1038/s41415-024-7834-5.

Cocaine- and Levamisole-Induced Vasculitis: Defining the Spectrum of Autoimmune Manifestations.

Iorio L, Davanzo F, Cazzador D, Codirenzi M, Fiorin E, Zanatta E J Clin Med. 2024; 13(17).

PMID: 39274328 PMC: 11396482. DOI: 10.3390/jcm13175116.

Oral Rehabilitation for a Patient with Cocaine-Induced Midline Destructive Lesions.

Berberi A, Azar E Case Rep Otolaryngol. 2024; 2024:7109261.

PMID: 38939732 PMC: 11208820. DOI: 10.1155/2024/7109261.

Mucocutaneous Manifestations of Recreational Drug Use.

Alexander-Savino C, Mirowski G, Culton D Am J Clin Dermatol. 2024; 25(2):281-297.

PMID: 38217568 DOI: 10.1007/s40257-023-00835-y.

References

Futran N, HALLER J . Considerations for free-flap reconstruction of the hard palate. Arch Otolaryngol Head Neck Surg. 1999; 125(6):665-9. DOI: 10.1001/archotol.125.6.665. View

Schonermarck U, Lamprecht P, Csernok E, Gross W . Prevalence and spectrum of rheumatic diseases associated with proteinase 3-antineutrophil cytoplasmic antibodies (ANCA) and myeloperoxidase-ANCA. Rheumatology (Oxford). 2001; 40(2):178-84. DOI: 10.1093/rheumatology/40.2.178. View

Gandara-Rey J, Diniz-Freitas M, Gandara-Vila P, Blanco-Carrion A, Garcia-Garcia A . Lesions of the oral mucosa in cocaine users who apply the drug topically. Med Oral. 2002; 7(2):103-7. View

Mari A, Arranz C, Gimeno X, Lluch J, Pericot J, Escuder O . Nasal cocaine abuse and centrofacial destructive process: report of three cases including treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93(4):435-9. DOI: 10.1067/moe.2002.121989. View

Trimarchi M, Nicolai P, Lombardi D, Facchetti F, Morassi M, Maroldi R . Sinonasal osteocartilaginous necrosis in cocaine abusers: experience in 25 patients. Am J Rhinol. 2003; 17(1):33-43. View

MESSINGER E . Narcotic septal perforations due to drug addiction. JAMA. 1962; 179:964-5. DOI: 10.1001/jama.1962.03050120000013. View

Savige J, Dimech W, Fritzler M, Goeken J, Hagen E, Jennette J . Addendum to the International Consensus Statement on testing and reporting of antineutrophil cytoplasmic antibodies. Quality control guidelines, comments, and recommendations for testing in other autoimmune diseases. Am J Clin Pathol. 2003; 120(3):312-8. DOI: 10.1309/WAEP-ADW0-K4LP-UHFN. View

Rowshani A, Schot L, Ten Berge I . c-ANCA as a serological pitfall. Lancet. 2004; 363(9411):782. DOI: 10.1016/S0140-6736(04)15694-8. View

Genden E, Wallace D, Okay D, Urken M . Reconstruction of the hard palate using the radial forearm free flap: indications and outcomes. Head Neck. 2004; 26(9):808-14. DOI: 10.1002/hed.20026. View

10.

Wiesner O, Russell K, Lee A, Jenne D, Trimarchi M, Gregorini G . Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for cocaine-induced midline destructive lesions but not autoimmune vasculitis. Arthritis Rheum. 2004; 50(9):2954-65. DOI: 10.1002/art.20479. View

11.

Goodger N, Wang J, Pogrel M . Palatal and nasal necrosis resulting from cocaine misuse. Br Dent J. 2005; 198(6):333-4. DOI: 10.1038/sj.bdj.4812171. View

12.

Padilla-Rosas M, Jimenez-Santos C, Garcia-Gonzalez C . Palatine perforation induced by cocaine. Med Oral Patol Oral Cir Bucal. 2006; 11(3):E239-42. View

13.

Di Cosola M, Turco M, Acero J, Navarro-Vila C, Cortelazzi R . Cocaine-related syndrome and palatal reconstruction: report of a series of cases. Int J Oral Maxillofac Surg. 2007; 36(8):721-7. DOI: 10.1016/j.ijom.2007.03.015. View

14.

Tartaro G, Rauso R, Bux A, Santagata M, Colella G . An unusual oronasal fistula induced by prolonged cocaine snort. Case report and literature review. Minerva Stomatol. 2008; 57(4):203-10. View

15.

Rachapalli S, Kiely P . Cocaine-induced midline destructive lesions mimicking ENT-limited Wegener's granulomatosis. Scand J Rheumatol. 2008; 37(6):477-80. DOI: 10.1080/03009740802192043. View

16.

Stahelin L, de Magalhaes Souza Fialho S, Neves F, Junckes L, Werner de Castro G, Pereira I . Cocaine-induced midline destruction lesions with positive ANCA test mimicking Wegener's granulomatosis. Rev Bras Reumatol. 2012; 52(3):431-7. View

17.

Rubin K . The manifestation of cocaine-induced midline destructive lesion in bone tissue and its identification in human skeletal remains. Forensic Sci Int. 2013; 231(1-3):408.e1-11. DOI: 10.1016/j.forsciint.2013.04.034. View

18.

Colletti G, Allevi F, Valassina D, Bertossi D, Biglioli F . Repair of cocaine-related oronasal fistula with forearm radial free flap. J Craniofac Surg. 2013; 24(5):1734-8. DOI: 10.1097/SCS.0b013e3182a2355a. View

19.

Colletti G, Autelitano L, Chiapasco M, Biglioli F, Giovanditto F, Mandala M . Comprehensive surgical management of cocaine-induced midline destructive lesions. J Oral Maxillofac Surg. 2014; 72(7):1395.e1-10. DOI: 10.1016/j.joms.2014.03.013. View

20.

Bianchi F, Gerbino G, Tosco P, Tanteri G, Gatti G, Ramieri G . Progressive midfacial bone erosion and necrosis: case report and differential diagnosis. J Craniomaxillofac Surg. 2014; 42(8):1698-703. DOI: 10.1016/j.jcms.2014.06.002. View