Sinonasal osteocartilaginous necrosis in cocaine abusers: Experience in 25 patients

Matteo Trimarchi, Piero Nicolai, Davide Lombardi, Fabio Facchetti, Maria Laura Morassi, Roberto Maroldi, Gina Gregorini, Ulrich Specks

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

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 fior 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)33-43
Number of pages11
JournalAmerican Journal of Rhinology
Volume17
Issue number1
StatePublished - Jan 2003

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Cocaine
Necrosis
Antibodies
Myeloblastin
Hard Palate
Soft Palate
Turbinates
Cocaine-Related Disorders
Nasal Mucosa
Palate
Nasal Cavity
Otolaryngology
Indirect Fluorescent Antibody Technique
Nose
Peroxidase
Substance-Related Disorders
Fluorescent Antibody Technique
Differential Diagnosis
Enzyme-Linked Immunosorbent Assay
Urine

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Trimarchi, M., Nicolai, P., Lombardi, D., Facchetti, F., Morassi, M. L., Maroldi, R., ... Specks, U. (2003). Sinonasal osteocartilaginous necrosis in cocaine abusers: Experience in 25 patients. American Journal of Rhinology, 17(1), 33-43.

Sinonasal osteocartilaginous necrosis in cocaine abusers : Experience in 25 patients. / Trimarchi, Matteo; Nicolai, Piero; Lombardi, Davide; Facchetti, Fabio; Morassi, Maria Laura; Maroldi, Roberto; Gregorini, Gina; Specks, Ulrich.

In: American Journal of Rhinology, Vol. 17, No. 1, 01.2003, p. 33-43.

Research output: Contribution to journalArticle

Trimarchi, M, Nicolai, P, Lombardi, D, Facchetti, F, Morassi, ML, Maroldi, R, Gregorini, G & Specks, U 2003, 'Sinonasal osteocartilaginous necrosis in cocaine abusers: Experience in 25 patients', American Journal of Rhinology, vol. 17, no. 1, pp. 33-43.
Trimarchi M, Nicolai P, Lombardi D, Facchetti F, Morassi ML, Maroldi R et al. Sinonasal osteocartilaginous necrosis in cocaine abusers: Experience in 25 patients. American Journal of Rhinology. 2003 Jan;17(1):33-43.
Trimarchi, Matteo ; Nicolai, Piero ; Lombardi, Davide ; Facchetti, Fabio ; Morassi, Maria Laura ; Maroldi, Roberto ; Gregorini, Gina ; Specks, Ulrich. / Sinonasal osteocartilaginous necrosis in cocaine abusers : Experience in 25 patients. In: American Journal of Rhinology. 2003 ; Vol. 17, No. 1. pp. 33-43.
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