title: Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review.
abstract: From November 1983 to April 1990, disseminated candidiasis was diagnosed in 83 heroin addicts at our institution. All patients had consumed brown heroin diluted in fresh lemon juice. Sixty-two (75%) had skin lesions, 41 (49%) had ocular lesions, and 35 (42%) had one or several costochondral tumors. Candida albicans was grown in culture or histopathologically identified in 34 cases (41%). The patients who had only cutaneous lesions were treated with ketoconazole, and they were all cured. The patients with ocular involvement received systemic amphotericin B with or without oral flucytosine; 29 of these patients developed varying degrees of vision loss. The method of treatment of costochondral tumors was not uniform; in 14 cases the lesions were resected. The one patient who died developed endocarditis involving the aortic valve. Cases of pleuropulmonary involvement, spondylitis, and large-joint arthritis have also been described among the 300 cases reported in the reviewed literature. This is a new syndrome of candidal infection in drug addicts who use brown heroin; ocular lesions are the most harmful manifestation, and loss of vision is the major sequela.
authors.affiliation: Infectious Diseases Unit, Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bisbe
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.forename: X
authors.initials: X
authors.lastname: Latorre
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: J
authors.initials: J
authors.lastname: Mallolas
authors.forename: J M
authors.initials: JM
authors.lastname: Gatell
authors.forename: J P
authors.initials: JP
authors.lastname: de la Bellacasa
authors.forename: E
authors.initials: E
authors.lastname: Soriano
mesh_terms: D000293:Adolescent; D000328:Adult; D002177:Candidiasis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006556:Heroin Dependence / Q000150:complications*; D006801:Humans; D008297:Male; D015819:Substance Abuse, Intravenous / Q000150:complications