title: Cutaneous manifestations of injectable drug use: hidden secrets.
abstract: Abscesses related to drug use are the most common cutaneous manifestations among injection drug users, often occurring when the veins become less accessible. In these cases, other techniques may be used to administer drugs, such as skin popping (subcutaneous injection) or muscle popping (intramuscular injection). The main risk factors for abscess formation include skin popping, use of unsterilized needles, and injection of speedball (a mixture of cocaine and heroin). We present a case of recurrent abscesses accompanied by fever, hypersomnia alternating with insomnia, diaphoresis, fatigue, recent weight loss, and agitation following subcutaneous injection of a tramadol, opipramol, and clonazepam mixture. Differential diagnoses included pyoderma gangrenosum on the basis of hepatitis C virus, skin lesions connected with human immunodeficiency virus infection, vasculitis, endocarditis, and serotonin syndrome. The patient was treated with oral antibiotics, surgical incision, and drainage of the abscesses, with consequent improvement.
authors.forename: Wioletta
authors.initials: W
authors.lastname: Barańska-Rybak
authors.affiliation: Department of Dermatology, Venereology, and Allergology, Medical University of Gdańsk, Debinki St 7, 80-211 Gdańsk, Poland. izabelaa5@wp.pl.
authors.forename: Izabela
authors.initials: I
authors.lastname: Błażewicz
authors.forename: Monika
authors.initials: M
authors.lastname: Kąkol
authors.forename: Mirosław
authors.initials: M
authors.lastname: Roter
authors.forename: Roman
authors.initials: R
authors.lastname: Nowicki
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D002998:Clonazepam / Q000008:administration & dosage / Q000009:adverse effects; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009888:Opipramol / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D018461:Soft Tissue Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014147:Tramadol / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014147:Tramadol; D002998:Clonazepam; D009888:Opipramol