Successful medical treatment of glans ischemia after voluntary buprenorphine injection.
BACKGROUND
The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection.


OBJECTIVE
We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below.


METHODS
A 26-year-old male drug addict presented with glans pain 4 days after self-injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis.


RESULTS
After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28-day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications.


CONCLUSIONS
To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy.
Department of Urology, Angers University Hospital, Angers, France.
François
F
Brecheteau
Pierre
P
Grison
Pierre
P
Abraham
Souhil
S
Lebdai
Steve
S
Kemgang
Vincent
V
Souday
Cosmina
C
Nedelcu
Thibaut
T
Culty
Stéphane
S
Larré
Abdel Rahmene
AR
Azzouzi
Pierre
P
Bigot
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000506:poisoning*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000506:poisoning*; D016972:Enterobacter cloacae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D006801:Humans; D007275:Injections, Intravenous; D007511:Ischemia / Q000139:chemically induced*; D008297:Male; D010413:Penis / Q000098:blood supply* / Q000187:drug effects / Q000473:pathology; D019966:Substance-Related Disorders; D014526:Urethritis / Q000382:microbiology
D000701:Analgesics, Opioid; D002047:Buprenorphine
Buprenorphine; Glans; Hyperbaric Oxygen Therapy; Ilomedin; Intravenous Injection; Ischemia; Laser Speckle Contrast Imaging; Penis