title: [A patient with both cocaine-induced nasal septum destruction and antibodies against anti-neutrophil cytoplasmic antibodies (ANCA); potential confusion with Wegener's disease].
abstract: A 37-year-old male cocaine user presented with continual, sanguinolent nasal obstruction and persistant pain following a nasal operation one year ago. Examination showed crustae, granulations and exposed septal cartilage in the right nasal passage in addition to a considerable septal deviation to the left. No other physical abnormalities were found. A biopsy of the nasal mucosa showed acute necrotic inflammation. The serological examination revealed markedly elevated anti-neutrophil cytoplasmic antibodies (ANCA) titres with positive reactions against proteinase-3, indicating Wegener's disease. Additional testing also showed a positive ANCA reaction for human neutrophil elastase, which made cocaine use a more plausible cause for the nasal abnormalities than Wegener's disease. Treatment consisted of nasal flushing with saline and, for a short period, a nasal tampon with hydrocortisone-oxytetracycline-polymyxin B ointment. However, the patient did, ultimately, develop a septal perforation. Cocaine-induced nasal abnormalities can imitate symptoms that may fit Wegener's disease, including relevant serological ANCA findings.
authors.affiliation: Antoni van Leeuwenhoek Ziekenhuis, afd. Keel-, Neus- en Oorheelkunde, Amsterdam.
authors.forename: R J
authors.initials: RJ
authors.lastname: Scheenstra
authors.forename: M
authors.initials: M
authors.lastname: van Buren
authors.forename: J P
authors.initials: JP
authors.lastname: Koopman
mesh_terms: D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D003042:Cocaine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D014890:Granulomatosis with Polyangiitis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D015508:Nasal Obstruction / Q000139:chemically induced / Q000209:etiology; D009300:Nasal Septum / Q000293:injuries*; D009668:Nose Diseases / Q000139:chemically induced* / Q000209:etiology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D003042:Cocaine