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A case series and literature review on patients with rhinological complications secondary to the use of cocaine and levamisole

Published online by Cambridge University Press:  20 May 2020

R J Green ,
Q Gardiner ,
K Vinod ,
R Oparka  and
P D Ross
R J Green*
Affiliation:
Department of ENT, Ninewells Hospital and Medical School, Dundee, Scotland, UK
Q Gardiner
Affiliation:
Department of ENT, Ninewells Hospital and Medical School, Dundee, Scotland, UK
K Vinod
Affiliation:
Department of Rheumatology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
R Oparka
Affiliation:
Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland, UK
P D Ross
Affiliation:
Department of ENT, Ninewells Hospital and Medical School, Dundee, Scotland, UK
*
Author for correspondence: Mr Richard James Green, ENT Department, Ninewells Hospital, DundeeDD1 9SY, Scotland, UK E-mail: Richard.green14@nhs.net Fax: +44 (0)1382 632816
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Abstract

Background

Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.

Methods

A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.

Results

Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.

Conclusion

As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.

Keywords

Anti-Neutrophil Cytoplasmic Antibody-Associated VasculitisNoseDeformitiesCocaineNasal Obstruction
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 5 , May 2020 , pp. 440 - 446
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Mr R J Green takes responsibility for the integrity of the content of the paper

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