heroin and Candidiasis--Cutaneous

Topics: Adult; Aged; Arthritis, Infectious; Candidiasis; Candidiasis, Cutaneous; Chorioretinitis; Heroin; Humans; Male; Osteoarthritis; Substance-Related Disorders

Systemic candidiasis in intravenous drug abusers (IVDA) is a new syndrome caused by Candida albicans and characterized by the sequential development of skin, eye, and osteoarticular lesions, which together form a typical clinical picture. We studied 30 patients with suggestive skin lesions: papules, nodules, and pustules in hair-bearing areas, particularly the scalp and beard area, associated with hair invasion by candidal hyphae. Ocular and osteoarticular involvement and presence of candidemia in some of the patients suggested blood-borne colonization of C. albicans. The infection has been related to "brown" heroin. The origin of C. albicans and the reasons for its exclusive localization in the skin and these organs are discussed. The characteristic clinical picture is widely different from that of classic disseminated candidiasis in immunodeficient patients. Therapy is also discussed.

Topics: Adult; Candidiasis; Candidiasis, Cutaneous; Female; Heroin; Humans; Male; Substance-Related Disorders

Seven young men developed similar manifestations of disseminated candidiasis after a single episode of intravenous heroin abuse. Sequential development of lesions of the eye, skin, and bone or costal cartilage was noted within 10 days after injection. Skin lesions were confined to the scalp and other hair bearing areas. Candida albicans was cultured readily from affected skin and costal cartilage. Histological examination of scalp biopsy specimens showed infiltration of hair follicles with chronic inflammatory cells and C albicans. Pseudohyphas of C albicans were also identified in and around hair shafts. The skin, skeletal, and small eye lesions resolved on systemic treatment with 1 g amphotericin B plus flucytosine. Pars plana vitrectomy plus local instillation of amphotericin B cured progressive chorioretinitis. These features may represent a distinctive syndrome of disseminated candidiasis in heroin abusers. Systemic antifungal treatment is curative in most cases.

Topics: Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Heroin; Humans; Male; Osteochondritis; Osteomyelitis; Ribs; Substance-Related Disorders; Syndrome