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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
Summary
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.
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