Abstract

Cocaine-induced midline destructive lesions (CIMDL) represent one of the rare but devastating consequences of cocaine addiction.

We report the case of a 52-year-old man with a history of severe and chronic cocaine addiction (up to 2g/d) for more than 25 years, who was referred by the ENT department for detoxification. The patient complained of repetitive epistaxis, nasal regurgitation with recurrent sinus infections, and chronic facial pain. On clinical examination, he showed necrosis of the septum complicated by a palatal perforation and presented a strong positivity for ANCA tests with a p-ANCA pattern. The CIMDL was retained after eliminating other etiological diagnoses.

The approach in the management of CIMDL is multidisciplinary, including dental professionals, maxillofacial surgeons, and psychologists.

The patient received initially conservative treatment with a palatal obturator prosthesis, but restarted cocaine intake 12 weeks after. There was progressing of the perforation with significant impact on the patient's quality of life.

In the present study, we review the available literature to discuss the diagnosis, and the therapeutics options in CIMDL, underlining the importance of abstinence as an absolute requirement, to consider surgical reconstruction.

Abbreviations:

CIMDL: Cocaine-Induced Destructive Midline Lesions; CUD: Cocaine Use Disorder; ANCA: Anti Neutrophil Cytoplasmic Antibodies; GPA: Granulomatosis with polyangiitis; cANCA: ANCA with cytoplasmic staining pattern; pANCA: ANCA with a perinuclear staining pattern; NE: neutrophil elastase

Keywords: Addiction, Addiction research, Addiction therapy, Cocaine-induced midline destructive lesions, CIMDL, Cocaine, Palatal perforations