Cocaine induced midline destructive lesions

Area of Science:

• Otolaryngology
• Pathology
• Toxicology

Background:

• Cocaine induced midline destructive lesions (CIMDL) are a significant clinical concern.
• These lesions often mimic systemic autoimmune diseases, particularly those with positive anti-neutrophil cytoplasmic antibodies (ANCA).

Purpose of the Study:

• To review the existing literature on cocaine induced midline destructive lesions (CIMDL).
• To elucidate the clinical manifestations, diagnostic features, and management of CIMDL.

Main Methods:

• A comprehensive literature search was conducted using the US National Library of Medicine (PubMed) database.
• The review encompassed English literature from January 1, 1982, to March 31, 2013, focusing on CIMDL involving nasal and surrounding structures.

Main Results:

• CIMDL affects approximately 4.8% of cocaine users, presenting with symptoms like hyposmia, facial pain, and destructive lesions of the nose, palate, sinuses, and skull base.
• A key diagnostic marker is the presence of ANCA directed against human neutrophil elastase (HNE).
• Diagnosis is supported by toxicological tests, immunofluorescence, antigen-specific assays, histopathology, apoptosis assays, and MRI.

Conclusions:

• Clinicians must promptly recognize CIMDL for effective management.
• Immunosuppressive therapy is not indicated for CIMDL.
• Cessation of cocaine use is the sole intervention capable of interrupting disease progression.