Penile Necrosis Associated with Local Intravenous Injection of Cocaine.

Area of Science:

• Urology
• Toxicology
• Emergency Medicine

Background:

• Cocaine is a highly addictive illicit drug with increasing use.
• Intravenous (i.v.) drug use causes significant venous injury, including ulceration and occlusion.
• The dorsal vein of the penis is an unusual but potential site for i.v. drug injection.

Observation:

• A 35-year-old man presented with severe penile and scrotal pain after injecting cocaine into the dorsal penile vein.
• Examination revealed penile and scrotal ulcerations, swelling, necrosis, and inguinal lymphadenopathy.
• Imaging confirmed penile edema and ulceration.

Findings:

• The patient's symptoms were attributed to i.v. cocaine injection into the dorsal penile vein.
• Infections such as Fournier gangrene and sexually transmitted diseases were ruled out.
• The patient improved with i.v. broad-spectrum antibiotics and local wound care.

Implications:

• This case underscores the importance of a detailed history from i.v. drug users.
• Physicians must counsel i.v. drug users on the severe complications of injecting into unusual anatomical locations.
• Awareness of these risks is crucial for appropriate diagnosis and management in emergency settings.