Cocaine-Induced Midline Destructive Lesions | |
---|---|
Other names | CIMDL |
Specialty | Rhinology |
Causes | Cocaine Insufflation |
Treatment | Surgery |
Frequency | 5% of cocaine users |
Cocaine-Induced Midline Destructive Lesions (CIMDL) is the progressive destruction of nasal architecture with the erosion of the palate, nasal conchae, and ethmoid sinuses associated with prolonged insufflation, colloquially 'snorting', of Cocaine. [1] The condition begins with erosion of mucusal lining and progress with damage to nasal cartilaginous and bony structures. [2]
CIMDL is also known colloquially as cocaine or coke nose. [2]
Patients with CIMDL present with chronic nasal obstruction, hyposmia, nose bleeding, and severe facial pain. More advanced cases present nasal septal perforation, diffuse necrotizing ulcerative lesions, nasal deformation, and palatal perforation. [2]
Due to its non-specific symptomatology, CIMDL is easily confused with other diseases such as infections, autoimmune, and granulomatous diseases, [3] albeit with some absent systemic symptoms such as fever, arthralgia, myalgia, CIMDL can be differentiated from systemic conditions. [4] Other markers for CIMDL include perinuclear anti-neutrophil cytoplasmic antibody(ANCA) and neutrophil elastase specific ANCA. [5]
Although not entirely understood, CIMDL is thought to be caused mainly by the vasoconstricting effects of cocaine, which induces ischemia and subsequent necrosis of the mucosal lining, followed by damage to nasal cartilaginous and bony structures. [2] Cocaine is also capable of inducing apoptosis of epithelial cells in a dose- and time- dependent manner, which may also contribute to the inflammatory tissue response against cocaine. [3]
The insufflation of cocaine crystals may also cause physical trauma to epithelial cells, leading to inflammatory lesions, which may also worsen due to the tendency for patients to physically remove the scabs produced in the damaged tissue, which induces further mechanical damage. [6]
Cocaine is capable of inducing apoptosis of epithelial cells in a dose- and time- dependent manner, which may also contribute to the inflammatory tissue response against cocaine. [3]
The only reliable treatment of CIMDL is cessation of cocaine abuse, which is considered a necessary prerequisite for surgical reconstruction. If abstention can be achieved, reconstructive surgery, prosthetics and medical therapy can achieve satisfactory results. Conservative treatment consists of regular saline douches, debridement of necrotic tissue and administration of antibiotics. [4]
Crohn's disease is a chronic inflammatory bowel disease characterized by recurrent episodes of intestinal inflammation, primarily manifesting as diarrhea and abdominal pain. Unlike ulcerative colitis, inflammation can occur anywhere in the gastrointestinal tract, though it most frequently affects the ileum and colon, involving all layers of the intestinal wall. Symptoms may be non-specific and progress gradually, often delaying diagnosis. About one-third of patients have colonic disease, another third have ileocolic disease, and the remaining third have isolated ileal disease. Systemic symptoms such as chronic fatigue, weight loss, and low-grade fevers are common. Organs such as the skin and joints can also be affected. Complications can include bowel obstructions, fistulas, nutrition problems, and an increased risk of intestinal cancers.
Inflammation is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function.
Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), after the German physician Friedrich Wegener, is a rare long-term systemic disorder that involves the formation of granulomas and inflammation of blood vessels (vasculitis). It is an autoimmune disease and a form of vasculitis that affects small- and medium-size vessels in many organs but most commonly affects the upper respiratory tract, lungs and kidneys. The signs and symptoms of GPA are highly varied and reflect which organs are supplied by the affected blood vessels. Typical signs and symptoms include nosebleeds, stuffy nose and crustiness of nasal secretions, and inflammation of the uveal layer of the eye. Damage to the heart, lungs and kidneys can be fatal.
Anti-neutrophil cytoplasmic antibodies (ANCAs) are a group of autoantibodies, mainly of the IgG type, against antigens in the cytoplasm of neutrophils and monocytes. They are detected as a blood test in a number of autoimmune disorders, but are particularly associated with systemic vasculitis, so called ANCA-associated vasculitides (AAV).
An oral medicine or stomatology doctor/dentist has received additional specialized training and experience in the diagnosis and management of oral mucosal abnormalities including oral cancer, salivary gland disorders, temporomandibular disorders and facial pain, taste and smell disorders; and recognition of the oral manifestations of systemic and infectious diseases. It lies at the interface between medicine and dentistry. An oral medicine doctor is trained to diagnose and manage patients with disorders of the orofacial region.
A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.
Adenoid hypertrophy, also known as enlarged adenoids refers to an enlargement of the adenoid that is linked to nasopharyngeal mechanical blockage and/or chronic inflammation. Adenoid hypertrophy is a characterized by hearing loss, recurrent otitis media, mucopurulent rhinorrhea, chronic mouth breathing, nasal airway obstruction, increased infection susceptibility, and dental malposition.
Sphingosine-1-phosphate (S1P) is a signaling sphingolipid, also known as lysosphingolipid. It is also referred to as a bioactive lipid mediator. Sphingolipids at large form a class of lipids characterized by a particular aliphatic aminoalcohol, which is sphingosine.
The human nose is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum, which separates the nostrils and divides the nasal cavity into two.
Neutrophil extracellular traps (NETs) are networks of extracellular fibers, primarily composed of DNA from neutrophils, which bind pathogens. Neutrophils are the immune system's first line of defense against infection and have conventionally been thought to kill invading pathogens through two strategies: engulfment of microbes and secretion of anti-microbials. In 2004, a novel third function was identified: formation of NETs. NETs allow neutrophils to kill extracellular pathogens while minimizing damage to the host cells. Upon in vitro activation with the pharmacological agent phorbol myristate acetate (PMA), Interleukin 8 (IL-8) or lipopolysaccharide (LPS), neutrophils release granule proteins and chromatin to form an extracellular fibril matrix known as NET through an active process.
Eosinophil cationic protein (ECP) also known as ribonuclease 3 is a basic protein located in the eosinophil primary matrix. In humans, the eosinophil cationic protein is encoded by the RNASE3 gene.
Serum amyloid A1 (SAA1) is a protein that in humans is encoded by the SAA1 gene. SAA1 is a major acute-phase protein mainly produced by hepatocytes in response to infection, tissue injury and malignancy. When released into blood circulation, SAA1 is present as an apolipoprotein associated with high-density lipoprotein (HDL). SAA1 is a major precursor of amyloid A (AA), the deposit of which leads to inflammatory amyloidosis.
Beta-defensin 2 (BD-2) also known as skin-antimicrobial peptide 1 (SAP1) is a peptide that in humans is encoded by the DEFB4 gene.
Necrotizing vasculitis, also called systemic necrotizing vasculitis, is a general term for the inflammation of veins and arteries that develops into necrosis and narrows the vessels.
Nasal administration, popularly known as snorting, is a route of administration in which drugs are insufflated through the nose. It can be a form of either topical administration or systemic administration, as the drugs thus locally delivered can go on to have either purely local or systemic effects. Nasal sprays are locally acting drugs such as decongestants for cold and allergy treatment, whose systemic effects are usually minimal. Examples of systemically active drugs available as nasal sprays are migraine drugs, rescue medications for overdose and seizure emergencies, hormone treatments, nicotine nasal spray, and nasal vaccines such as live attenuated influenza vaccine.
Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is a rare type of lymphoma that commonly involves midline areas of the nasal cavity, oral cavity, and/or pharynx At these sites, the disease often takes the form of massive, necrotic, and extremely disfiguring lesions. However, ENKTCL-NT can also involve the eye, larynx, lung, gastrointestinal tract, skin, and various other tissues. ENKTCL-NT mainly affects adults; it is relatively common in Asia and to lesser extents Mexico, Central America, and South America but is rare in Europe and North America. In Korea, ENKTCL-NT often involves the skin and is reported to be the most common form of cutaneous lymphoma after mycosis fungoides.
Heterophyes heterophyes, or the intestinal fish fluke, was discovered by Theodor Maximaillian Bilharz in 1851. This parasite was found during an autopsy of an Egyptian mummy. H. heterophyes is found in the Middle East, West Europe and Africa. They use different species to complete their complex lifestyle. Humans and other mammals are the definitive host, first intermediate host are snails, and second intermediate are fish. Mammals that come in contact with the parasite are dogs, humans, and cats. Snails that are affected by this parasite are the Cerithideopsilla conica. Fish that come in contact with this parasite are Mugil cephalus, Tilapia milotica, Aphanius fasciatus, and Acanthgobius sp. Humans and mammals will come in contact with this parasite by the consumption of contaminated or raw fish. This parasite is one of the smallest endoparasite to infect humans. It can cause intestinal infection called heterophyiasis.
Cocaine intoxication refers to the subjective, desired and adverse effects of cocaine on the mind and behavior of users. Both self-induced and involuntary cocaine intoxication have medical and legal implications.
Interleukin 36, or IL-36, is a group of cytokines in the IL-1 family with pro-inflammatory effects. The role of IL-36 in inflammatory diseases is under investigation.