title: [Acute cutaneous symptom complex with subsequent cataract. The internet drug MT-45 may be the cause].
abstract: The number of new psychoactive substances (»NPS«) sold by online drug vendors (»Internet drugs«) shows a steady increase. Over a short time period in 2013-2014, three Swedish men aged 23-34 years with suspected drug use experienced similar but unusual clinical symptoms including loss and depigmentation of hair, widespread folliculitis and dermatitis, painful intertriginous dermatitis, dryness of eyes, and elevated liver enzymes. Two also had lines of discoloration across the nails (»Mees' lines«) of the fingers and toes. The symptoms gradually disappeared over time. However, two of them subsequently developed severe bilateral secondary cataracts requiring surgery. Blood tests for NPS performed within the Swedish STRIDA project demonstrated intake of the synthetic opioid MT-45, a piperazine derivative originally synthesized as a therapeutic drug candidate in the 1970s, in all three patients, suggesting this as a possible common causative agent. These clinical cases highlight the importance for physicians to consider the increasing number of untested recreational drugs as a potential cause of unusual clinical symptoms.
authors.affiliation: Institutionen för Medicin - Hudkliniken, Karolinska i Solna Stockholm, Sweden Institutionen för Medicin - Department of dermatology Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Bradley
authors.affiliation: Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden.
authors.forename: Anja
authors.initials: A
authors.lastname: Hasselblad
authors.affiliation: Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Norlen
authors.affiliation: Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden Karolinska Universitetssjukhuset - Hudkliniken Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Lapins
authors.affiliation: Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Bäckberg
authors.affiliation: Karolinska Institutet - Labmed Stockholm, Sweden Karolinska Institutet - Labmed Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Helander
mesh_terms: D000328:Adult; D000505:Alopecia / Q000139:chemically induced; D000701:Analgesics, Opioid / Q000506:poisoning*; D002386:Cataract / Q000139:chemically induced*; D015198:Designer Drugs / Q000506:poisoning*; D003875:Drug Eruptions / Q000209:etiology; D006801:Humans; D013287:Illicit Drugs / Q000506:poisoning; D020407:Internet; D008297:Male; D010859:Pigmentation Disorders / Q000139:chemically induced; D010879:Piperazines / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D015198:Designer Drugs; D013287:Illicit Drugs; D010879:Piperazines; C012631:(+,-)-1-cyclohexyl-4-(1,2-diphenylethyl)piperazine