Cocaïne et lésions destructrices centro-faciales : à propos d'un cas

Rev Med Interne. 2020 Sep;41(9):622-627. doi: 10.1016/j.revmed.2020.04.010. Epub 2020 Jul 11.
[Article in French]

Abstract

Introduction: Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed.

Case report: A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made.

Conclusion: CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.

Keywords: ANCA; Cocaine; Cocaine induced midline destructive lesions; Cocaïne; Nasal septum perforation; Perforation du septum nasal.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Antineutrophil Cytoplasmic / adverse effects
  • Antibodies, Antineutrophil Cytoplasmic / blood
  • Cocaine-Related Disorders / complications*
  • Cocaine-Related Disorders / diagnosis
  • Diagnosis, Differential
  • Granuloma, Lethal Midline / diagnosis
  • Granuloma, Lethal Midline / etiology
  • Granulomatosis with Polyangiitis / diagnosis
  • Granulomatosis with Polyangiitis / etiology*
  • Humans
  • Male
  • Nasal Septal Perforation / diagnosis
  • Nasal Septal Perforation / etiology*

Substances

  • Antibodies, Antineutrophil Cytoplasmic