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Cocaine-Induced Four-Extremity Ischemia Caused by a Hypercoagulable State

Victoria Echevarria1, Alexandra C Echevarria2, Damian Casadesus3

  • 1Internal Medicine, American University of the Caribbean, Sint Maarten, MAF.

Cureus
|October 9, 2023
PubMed

Insights

Chronic cocaine use can lead to rare but severe limb ischemia. This case highlights cocaine-induced thrombotic microangiopathy affecting all four limbs, a serious complication with unclear pathophysiology.

Area of Science:

  • Vascular Medicine
  • Toxicology
  • Hematology

Background:

  • Cocaine use is linked to various ischemic complications affecting multiple organ systems.
  • Limb ischemia is a rare but serious potential side effect of chronic cocaine abuse.

Observation:

  • A 50-year-old female with a history of extensive cocaine use presented with ischemia in all four limbs.
  • Imaging revealed pulmonary emboli, multisystem thromboses, and cerebral microhemorrhages.
  • Laboratory findings included leukocytosis, thrombocytopenia, and schistocytes, with normal rheumatologic and hematologic evaluations.

Findings:

  • The patient was diagnosed with cocaine-induced thrombotic microangiopathy (CITM).
  • Treatment involved symptomatic management and continuous heparin infusion.
  • Despite treatment, the patient was lost to follow-up.

Implications:

  • Cocaine-induced thrombotic microangiopathy is a rare condition with limited reported cases.
  • The exact pathophysiology of CITM remains poorly understood and requires further investigation.
  • This case underscores the severe systemic vascular risks associated with chronic cocaine consumption.

Keywords:
cocaine hypercoagulable statecocaine-induced thrombosisdrug-induced ischemialimb ischemialimb thrombosis

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