Renal infarction associated with intravenous cocaine use

The use of illicit cocaine continues to grow. This report is a documented case of renal infarction from intravenous cocaine use. The authors postulate that increased adrenergic stimulation from the intravenous cocaine, in association with an existing arterial thrombus, led to end organ infarction. This resulted in transient hypertension, but no long-term morbidity. The implications of this report extend to all patients with underlying arterial disease who use cocaine illicitly. Physicians and health professionals should be aware of this danger from intravenous cocaine usage.     

Necrotizing granulomatous vasculitis associated with cocaine use

Cocaine abuse may be associated with a destructive nasal and pharyngeal process felt to be due to ischemia secondary to vasoconstriction. This report is the first to document a necrotizing granulomatous vasculitis associated with nasal destruction and an oronasal fistula in a chronic cocaine user. Cocaine is an environmental insult that may play a role in triggering cerebral and non-cerebral vasculitis including a necrotizing granulomatous vasculitis of the respiratory tract.     

Perinatal outcome associated with PCP versus cocaine use

Phencyclidine (PCP) remains a widely used illicit drug, especially among adolescents and young adults. The pharmacologic effects of PCP are similar to those of cocaine; therefore, in this retrospective study 37 PCP-intoxicated parturients were matched for ethnicity, tobacco use, age, gravidity, and degree of prenatal care with 37 cocaine-intoxicated parturients. Infants exposed to PCP in utero, like those exposed to cocaine, had a high incidence of intrauterine growth retardation (32 vs 19%, N.S.), precipitate labor (43 vs 27%, N.S.), symptoms of neonatal drug withdrawal/intoxication, and prolonged neonatal hospitalizations. Moreover, they were more likely to have meconium-stained amniotic fluid (30 vs 19%, p = .05) and less likely to be born prematurely as cocaine-exposed infants. The comparison between the long-term developmental outcome of these groups awaits further study.     

Hyponatremia associated with levamisole-adulterated cocaine use in emergency department patients

An increasing percentage of US cocaine has been adulterated with levamisole, an immunomodulator associated with agranulocytosis. We describe 3 emergency department patients with hyponatremia and cocaine use. Despite extensive evaluation, the cause of the hyponatremia was not elucidated but resolved during hospitalization. Because hyponatremia has not previously been associated with cocaine, we sought to uncover a plausible explanation that might be contributing to this new finding. Levamisole was detected in all 3 patients. Although we are unable to confirm causality, we propose that levamisole-adulterated cocaine may have contributed to the hyponatremia described in these patients.     

Violent behaviors associated with cocaine use: possible pharmacological mechanisms.

Violent behaviors are increasingly noted in clinical practice to be associated with cocaine use; however, few studies actually characterize these behaviors. Cocaine addicts who made self-inquiries for themselves to obtain information about the effects, diagnosis, and treatment of cocaine dependence were interviewed. The study examined in a structured telephone interview their violent behaviors associated with cocaine use. The types of violent behavior reported by these cocaine addicts ranged from minor psychological aggressions to major physical acts that included murder and rape. The pharmacological mechanisms underlying the induction of cocaine-associated violence may involve known neurotransmitter systems affected by cocaine. A possible explanation may be that cocaine acts in those areas of the brain, particularly the limbic system, that subserve aggressive and violent behaviors.     

Habitual cocaine use is associated with high defibrillation threshold during ICD implantation

Background: Habitual cocaine use can lead to dilated cardiomyopathy (DCM) and sudden cardiac death. Based on prior clinical observations, we hypothesized that prior habitual cocaine use is a strong predictor of high defibrillation threshold (DFT) during implantable cardioverter-defibrillator (ICD) implant.
Methods: We reviewed the medical records of 130 consecutive patients undergoing initial ICD implantation or revision at Parkland Hospital and the Dallas VA Hospital, Dallas, TX, from January 2002 to November 2005. Patient characteristics and DFT data were collected retrospectively.
Results: The study group includes 11 patients (8.46%) who were identified as having a history of prior habitual cocaine use as demonstrated by history and urine toxicology; the rest (119 patients) form the control group. Cocaine-using patients tended to be younger (48.2 ± 10 vs 60.1 ± 12.3 years; P = 0.0026), were less likely to have coronary disease (36.3% vs 72.2%; P = 0.032), and had less comorbidity. The average DFT was 27.9 ± 7.8 J for all cocaine-using patients and 14.5 ± 4.1 J for noncocaine-using patients (P = 0.00018). In the cocaine-using group, three out of 11 patients required a subcutaneous array compared to none in the control group.
Conclusions: Our results suggest that patients with a history of habitual cocaine use may be at increased risk to have a high DFT during ICD implantation. This is the first study to demonstrate such association. ICD implantation in patients with this history should be planned with these findings in mind, as larger output generators or subcutaneous arrays might be required.     

Left main coronary artery and femoral artery vasospasm associated with cocaine use

A woman had diffuse vascular spasm related to cocaine use. She presented with evidence of an acute anterior myocardial infarction but had no rise in creatinine phosphokinase levels. Cardiac catheterization showed 90 percent proximal left main coronary artery narrowing. The catheterization was complicated by right femoral artery spasm. A repeat catheterization after treatment with nitroglycerin and diltiazem showed 30 percent proximal left main coronary artery narrowing. This catheterization was complicated by left femoral artery spasm. An exercise treadmill test was negative for ischemia.     

Cutaneous vasculitis associated with pheochromocytoma

We describe a patient who presented with constitutional symptoms, severe hypertension, and purpuric lesions over the knees, thighs, and penis. The patient was eventually diagnosed as having multiple endocrine neoplasia type II, with cutaneous leukocytoclastic vasculitis. The cutaneous vasculitis persisted despite treatment with high-dose systemic corticosteroids, but rapidly resolved after the removal of bilateral pheochromocytomas. This case demonstrates cutaneous leukocytoclastic vasculitis in association with pheochromocytoma.     

Cutaneous vasculitis associated with fluoroquinolones

Cutaneous vasculitis is a clinical entity with a broad differential diagnosis, including an adverse drug reaction. It is defined as inflammation of skin blood vessel walls. During a 7-year-period, we observed three patients who developed isolated cutaneous vasculitis during antibiotic therapy of bacterial infection. All were treated with a fluoroquinolone (ciprofloxacin or levofloxacin) combined with rifampin (two cases) or flucloxacillin (three cases), respectively. In all three cases the lesions gradually resolved after treatment with the inciting fluoroquinolone had been stopped. In one patient, leukocytoclastic small-vessel vasculitis was histologically confirmed. Fluoroquinolone-associated cutaneous vasculitis consists of an isolated self-limiting disorder that is part of a systemic vasculitis, or even life-threatening disease. Clinicians should be aware of this serious adverse event because any continuation of treatment may be fatal.     

Cutaneous vasculitis associated with rofecoxib

SIR, We read with interest the recent letter concerning a celecoxib-inducedcutaneous vasculitis [1]. There are no such case reports concerningrofecoxib. There have now been several case reports recentlydocumenting cutaneous vasculitis in association with the cyclooxygenase2 (COX-2)-specific non-steroidal anti-inflammatory drug (NSAID)celecoxib [1–3]. One case of fatal allergic vasculitis,described in Lancet [2     

Myocardial infarction associated with cocaine abuse

We report a patient who sustained a myocardial infarction after inhaling cocaine. He developed a persistent wall motion defect that was present 18 months after the acute event despite resolution of electrocardiographic evidence of infarction.