buprenorphine and Skin-Diseases--Vascular

Skin biopsies were performed in a patient with livedoid and necrotic lesions of the forearm. Periodic acid-Schiff-stained and birefringent Maltese cross-patterned foreign bodies were observed in capillary vessels. It was consistent with the diagnosis of intra-arterial injections of a substance containing corn starch. This finding confirmed the clinical diagnosis of intra-arterial injection of solubilized tablets of buprenorphine. This case constitutes a rare clinical presentation of foreign bodies injections in a drug addict.

Topics: Adult; Biopsy; Buprenorphine; Foreign Bodies; Humans; Injections, Intra-Arterial; Male; Narcotic Antagonists; Necrosis; Skin; Skin Diseases, Vascular; Substance-Related Disorders

Use of buprenorphine (Subutex) is widely used as substitution treatment in opiate addiction although its side-effects are little known. We report a case of localised necrotic livedo subsequent to injection of Subutex.. A 34 year-old male drug addict on Subutex substitution treatment presented a necrotic livedo and an ulcer with clearly demarcated edges on the skin of the inner elbow. Histological analysis revealed PAS-positive particles in a hypodermic inflammatory lymphohistiocytic infiltrate that were reflective and formed a Maltese cross under polarised light and were identified as maize starch.. This clinical case describes necrotic livedo lesions induced by injection of Subutex. The underlying mechanisms are associated with maize starch, an excipient used in Subutex. Unauthorised subcutaneous injection of buprenorphine (Subutex) is common among drug addicts but there is little description of the associated complications. In our patient, the presence in cutaneous biopsy samples of maize starch, an excipient of buprenorphine, provides evidence of intravenous administration of this drug.

Topics: Adult; Buprenorphine; Excipients; Humans; Injections, Subcutaneous; Male; Narcotics; Necrosis; Skin Diseases, Vascular; Starch; Substance Abuse, Intravenous