Sinonasal osteocartilaginous necrosis in cocaine abusers: experience in 25 patients.
BACKGROUND
Cocaine-induced lesions may cause extensive destruction of the osteocartilaginous structures of the nose, sinuses, and palate that mimics the clinical picture of other diseases.


METHODS
From January 1991 to September 2001 25 patients with cocaine-induced midline destructive lesions were observed at the Department of Otorhinolaryngology of the University of Brescia. The diagnosis was based on physical and endoscopic evaluation, routine blood and urine analysis, radiological findings, and repeated biopsies of the nasal mucosa. Serum was analyzed by the antineutrophilic cytoplasmic antibody (ANCA) test using indirect immunofluorescence and by enzyme-linked immunosorbent assay for antibodies against proteinase 3 and myeloperoxidase.


RESULTS
Septal perforation was present in all 25 patients, 16 of which (68%) also had partial destruction of the inferior turbinate. Hard palate reabsorption was observed in only six patients (24%); in two of these patients, the lesion also extended to the soft palate. Fourteen patients (56%) were positive by the immunofluorescence test (nine patients had a P-ANCA and five patients a C-ANCA pattern). Four patients (16%) with the P-ANCA pattern and all patients with the C-ANCA pattern also tested positive for anti-proteinase 3 antibodies.


CONCLUSIONS
Any sinonasal inflammation involving the midline that persists or remains refractory to treatment may be the first manifestation of potentially lethal drug addiction. Cocaine abuse should be considered in the differential diagnosis of destructive lesions of the nasal cavity even in the presence of a positive ANCA test.
Trimarchi
Matteo
M
Department of Otorhinolaryngology, University of Brescia, Italy.
Nicolai
Piero
P
Lombardi
Davide
D
Facchetti
Fabio
F
Morassi
Maria Laura
ML
Maroldi
Roberto
R
Gregorini
Gina
G
Specks
Ulrich
U
D000328:Adult; D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic; D015703:Antigens, CD; D001706:Biopsy; D002357:Cartilage Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D016145:Endoscopy, Digestive System; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053146:Myeloblastin; D009666:Nose / Q000473:pathology*; D009668:Nose Diseases / Q000139:chemically induced* / Q000175:diagnosis; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis; D012697:Serine Endopeptidases; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
D019268:Antibodies, Antineutrophil Cytoplasmic; D015703:Antigens, CD; D014662:Vasoconstrictor Agents; D012697:Serine Endopeptidases; D053146:Myeloblastin; D003042:Cocaine