heroin and Necrosis

We present fatal extensive soft tissue infections, a consequence of groin heroin injection, in three subjects, who were 27, 34, and 39 years old and had a history of over 10-, 15-, and 5-years of heroin injection (cases 1, 2, and 3, respectively). In all cases, the first symptoms of the infection appeared at least a week prior, with rapid deterioration on the last day. The hallmark was a disproportion between external and internal findings in the affected thighs. The latter presented as extensively spread suppurative inflammation with soft tissue necrosis. In case 1, subtle skin erythema was present in the left groin, with a wound suggestive of a recent abscess incision and injection-related scarring. However, dissection revealed that inguinal regions and deep soft tissue (including the muscle sheets) of the left thigh, gluteal region, and lower third of the anterior abdominal wall were inflamed with pus, alongside fibrinopurulent peritonitis. Case 2 had pronounced erythema and swelling of the thigh and knee. Diffuse suppuration was observed upon dissection in the inguinal regions, which extended into the iliopsoas muscles, with soft tissue and muscle necrosis. In the abdominal cavity, we detected 150 mL of serofibrinous exudate. Only case 3 had a prominent, 4 × 3.5-cm necrotic skin defect through which pus spontaneously drained. In contrast to the other two, although extensive pus collection within predominantly necrotic thigh's soft tissue was present, the inflammation did not expand above the inguinal ligament, and peritonitis was not observed. Toxicology analysis excluded acute heroin intoxications.

Topics: Abscess; Groin; Heroin; Humans; Necrosis; Soft Tissue Infections

The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.. The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.. The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.

Topics: Administration, Intranasal; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Necrosis; Nose; Opiate Substitution Treatment; Palate, Soft; Pharynx

Cocaine and heroin are frequently co-abused by humans, in a combination known as speedball. Recently, chemical interactions between heroin (Her) or its metabolite morphine (Mor) and cocaine (Coc) were described, resulting in the formation of strong adducts. In this work, we evaluated whether combinations of Coc and Her affect the neurotoxicity of these drugs, using rat cortical neurons incubated with Coc, Her, Her followed by Coc (Her+Coc) and Her plus Coc (Her:Coc, 1:1). Neurons exposed to Her, Her+Coc and Her:Coc exhibited a decrease in cell viability, which was more pronounced in neurons exposed to Her and Her+Coc, in comparison with neurons exposed to the mixture (Her:Coc). Cells exposed to the mixture showed increased intracellular calcium and mitochondrial dysfunction, as determined by a decrease in intracellular ATP levels and in mitochondrial membrane potential, displaying both apoptotic and necrotic characteristics. Conversely, a major increase in cytochrome c release, caspase 3-dependent apoptosis, and decreased metabolic neuronal viability were observed upon sequential exposure to Her and Coc. The data show that drug combinations potentiate cortical neurotoxicity and that the mode of co-exposure changes cellular death pathways activated by the drugs, strongly suggesting that chemical interactions occurring in Her:Coc, such as adduct formation, shift cell death mechanisms towards necrosis. Since impairment of the prefrontal cortex is involved in the loss of impulse control observed in drug addicts, the data presented here may contribute to explain the increase in treatment failure observed in speedball abusers.

Topics: Adenosine Triphosphate; Animals; Apoptosis; Caspase 3; Cell Survival; Cerebral Cortex; Cocaine; Cytochromes c; Drug Interactions; Heroin; Membrane Potential, Mitochondrial; Necrosis; Neurons; Neurotoxicity Syndromes; Rats

An 18-year-old woman presented with severe features of seborrhoeic dermatitis involving her scalp. Subsequently, the toe webs and intertriginous areas became affected by an erythematous, slightly scaly and weepy rash. The groin area was most severely affected, and complicated by intermittent infections with staphylococci and herpes simplex. The patient admitted to smoking heroin and was subsequently enrolled in a methadone programme. A biopsy from the groin area showed a combination of parakeratosis and keratinocyte vacuolar changes, supporting a diagnosis of necrolytic migratory erythema (NME). On completion of methadadone withdrawal, the rash cleared. The rash returned upon recommencing methadone. NME consists of an irregular annular eruption with an erythematous crusted edge. It is often mistaken for intertrigo or seborrhoeic dermatitis. In this patient, a direct effect of heroin and methadone on the epidermal metabolism might be speculated. There could be a variant of the opiate recepter, which is especially sensitive to the effects of opiates. This is the second case occurring in association with opiate dependency and the first case where the patient was rechallenged, although the precise role of the opiates in the aetiology remains somewhat speculative.

Topics: Adolescent; Analgesics, Opioid; Diagnosis, Differential; Erythema; Female; Heroin; Humans; Methadone; Necrosis; Opioid-Related Disorders; Scalp Dermatoses

We present an unusual case of breast ulceration secondary to heroin injection in a pregnant woman.

Topics: Adult; Breast Diseases; Cellulitis; Female; Heroin; Heroin Dependence; Humans; Narcotics; Necrosis; Pregnancy; Pregnancy Complications; Ulcer

Topics: Adult; Heroin; Heroin Dependence; Humans; Injections; Male; Necrosis; Scalp Dermatoses; Skin; Skin Ulcer

Rhabdomyolysis is one of the less known complications of heroin abuse. A case of lower leg muscle necrosis after nasal application of heroin is reported with repeated resection of the necrotic muscles. Superinfection with a methicillin-resistant Staphylococcus aureus (MRSA) strain was present. After 4 weeks, bilateral amputation could not be avoided. We regard a direct toxic effect of the heroin as the most probable mechanism of the muscular damage, with possible influence of the reduced oxygen delivery due to central respiratory and circulatory depression.

Topics: Administration, Intranasal; Adult; Amputation, Surgical; Heroin; Heroin Dependence; Humans; Leg; Male; Muscle, Skeletal; Necrosis; Oxygen; Respiration

A molecular epidemiologic investigation was performed on a cluster of severe necrotizing Clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in Clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a Clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.

Topics: Adult; Clostridium Infections; Clostridium perfringens; Debridement; Disease Outbreaks; Female; Heroin; Humans; Male; Molecular Epidemiology; Necrosis; San Francisco; Soft Tissue Infections; Substance Abuse, Intravenous

We report a case of biopsy proven myocardial damage after opiate-induced rhabdomyolysis. Myocardial biopsy showed focal lesions formed by small mononuclear inflammatory cells with a few neutrophils, associated with degenerated and necrotic myocardial fibers, interstitial edema and congestion of intrinsic blood vessels. These findings were similar to those seen with other drug overdoses if combined with strenuous muscular effort or hypoxic coma. We hypothesize that myocardial damage is a consequence of intracapillary myohypoxia associated with prolonged hypoxic coma following opiate overdose.

Topics: Adult; Biopsy; Cardiomyopathies; Cell Hypoxia; Coma; Drug Overdose; Heart; Heroin; Humans; Male; Myocardium; Narcotics; Necrosis; Rhabdomyolysis

Electron microscopic analysis was used to study the ultrastructural changes taking place in rat soleus muscle following intraperitoneal administration of pure heroin. Degenerative changes observed consisted primarily of hypercontracted fibers at different stages of development. Evidence of regeneration was also found. Results show the myotoxic effect of pure heroin on skeletal muscle. The pathogenesis of muscle damage is discussed.

Topics: Animals; Eosinophils; Heroin; Macrophages; Male; Muscles; Myofibrils; Necrosis; Rats; Rats, Wistar; Sarcolemma

The effects of heroin on rat skeletal muscle was studied. Heroin was injected intraperitoneally, and the soleus and tibial anterior muscles were studied using histological and histochemical techniques. Degenerative and regenerative changes were detected, the latter proving more significant. The soleus was the only muscle affected, the anterior tibial showing no sign of damage. The heroin myopathy model may be valuable in studying muscle fibre necrosis and regeneration.

Topics: Animals; Heroin; Injections, Intraperitoneal; Male; Muscles; Necrosis; Rats; Rats, Inbred Strains; Regeneration

Ingested cocaine can be a cause of severe bowel ischemia or gangrene. Two cocaine addicts who ingested large quantities of the drug developed severe abdominal symptoms and signs caused by bowel ischemia. In one patient gangrene of the bowel necessitated repeated resections and was followed, several weeks later, by death. The other patient suffered less severe ischemia and the bowel returned to normal. The diagnosis of bowel ischemia should be suspected whenever a cocaine addict has severe abdominal symptoms and signs. The presence of marked leukocytosis suggests bowel gangrene and demands prompt surgical intervention.

Topics: Adult; Cocaine; Colectomy; Colon; Female; Gangrene; Gastrointestinal Hemorrhage; Heroin; Humans; Ileostomy; Ileum; Intestinal Obstruction; Intestines; Ischemia; Necrosis; Substance-Related Disorders; Suicide, Attempted

Topics: Adult; Aneurysm; Brain; Ganglia, Spinal; Globus Pallidus; Heroin; Humans; Hypotension; Infarction; Male; Morphine Dependence; Muscular Atrophy; Necrosis; Peripheral Nerves; Spinal Cord

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Adult; Amobarbital; Barbiturates; Biopsy; Blister; Coma; Erythema; Heroin; Humans; Male; Nalorphine; Necrosis; Prednisone; Secobarbital; Skin; Skin Diseases; Sweat Glands

Topics: Adult; Anesthesia, General; Asphyxia; Barbiturates; Brain; Brain Diseases; Female; Forensic Medicine; Globus Pallidus; Heart Arrest; Heroin; Humans; Hypoxia, Brain; Injections, Intravenous; Male; Middle Aged; Morphine Dependence; Necrosis; Peptic Ulcer Perforation; Suicide