Digital ischemia in clandestine intravenous drug users

Five young adults were seen initially with digital ischemia without a history of trauma or underlying systemic illness. After careful evaluation and treatment, inadvertent intraarterial drug injection was found to be the cause of the ischemia. The diagnosis was initially overlooked because the patients did not offer a history of drug abuse and did not appear like the stereotypical drug user. These patients may be seen early or several months after their accidental intraarterial injection. With the increase in drug abuse today, all segments of society can be affected. This diagnosis should be considered in any patient with unexplained digital ischemia.