Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis

Michele Di Cosola, Mariateresa Ambrosino, Luisa Limongelli, Gianfranco Favia, Andrea Santarelli, Roberto Cortelazzi and Lorenzo Lo Muzio
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Michele Di Cosola: Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
Mariateresa Ambrosino: Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
Luisa Limongelli: Department of Interdisciplinary Medicine, Odontostomatology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy
Gianfranco Favia: Department of Interdisciplinary Medicine, Odontostomatology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy
Andrea Santarelli: Department of Clinic Specialistic and Stomatological Sciences, Polytechnic University of Marche, 60121 Ancona, Italy
Roberto Cortelazzi: Department of Interdisciplinary Medicine, Odontostomatology Unit, University of Bari “Aldo Moro”, 70121 Bari, Italy
Lorenzo Lo Muzio: Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy

IJERPH, 2021, vol. 18, issue 15, 1-7

Abstract: The prolonged use of intranasal cocaine can destroy the nasal architecture with the erosion of the palate, turbinates, and ethmoid sinuses causing cocaine-induced midline lesions (CIMDL). The CIMDL display a clinical pattern mimicking variable diseases. The aim of this study was to highlight the difficulties in reaching a correct diagnosis through the evaluation of eight new cases. The diagnostic procedures followed in these patients included: detailed medical history, clinical and histological examination, computed tomography and magnetic resonance imaging, laboratory findings (complete blood count, sedimentation rate, antinuclear antibody test, rheumatoid factor, venereal disease research laboratory test, leishmaniasis and fungal serology, antineutrophil cytoplasmic antibodies ANCA test), and chest X-ray. All patients complained of epistaxis, halitosis, nasal scabs and obstruction, decreased sense of smell and/or taste, oro-nasal regurgitation of solids and liquids with recurrent sinus infections, and chronic facial pain. On clinical examination, all patients showed palate perforation with variable nasal structure involvement and presented a strong positivity for ANCA tests with a p-ANCA pattern. The followed protocol for the CIMDL diagnosis allowed for a relatively quick and conclusive diagnosis in all patients. A multidisciplinary approach is mandatory in the management of CIMDL, involving dental professionals, maxillofacial surgeons, and psychologists.

Keywords: cocaine; palate perforation; cocaine-induced midline destructive lesion; CIMDL (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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