Book review

https://doi.org/10.20471/acc.2024.63.02.21

Cocaine-induced midline destructive lesions

Hanna Pašić ; Department of Psychiatry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia *
Branka Vidrih ; Department of Psychiatry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; School of Medicine, Catholic University of Croatia, Zagreb, Croatia
Iva Šarac ; School of Medicine, University of Zagreb, Zagreb, Croatia
Nina Rotim ; School of Medicine, University of Zagreb, Zagreb, Croatia
Ana Hrkać Pustahija ; Department of Neuroradiology, Zagreb University Hospital Center, Zagreb, Croatia
Branko Malojčić ; School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Neurology, Zagreb University Hospital Center, Zagreb, Croatia
Ivana Karla Franić ; Department of Neurology, Zagreb University Hospital Center, Zagreb, Croatia
Ivona Radmanović ; Department of Neurology, Sisak General Hospital, Sisak, Croatia
Maja Živković ; School of Medicine, University of Zagreb, Zagreb, Croatia; Department of Psychiatry, Zagreb University Hospital Center, Zagreb, Croatia
Stjepan Jurić ; Department of Neurology, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
Jelena Šarić-Jurić ; Department of Neurology, Osijek University Hospital Center, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
Marija Bošnjak Pašić ; Department of Neurology, Zagreb University Hospital Center, Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia

* Corresponding author.

Abstract

Prolonged cocaine inhalation can cause destruction of nasal mucosa and ethmoid
sinuses and palate perforation, thus inducing cocaine-induced midline destructive lesions (CIMDL)
that affect only a limited number of predisposed patients. CIMDL are an autoimmune necrotizing
inflammatory phenomenon associated with the presence of atypical antineutrophil cytoplasmic
antibody (ANCA). Patients complain of epistaxis, nasal obstruction, hyposmia, sinus infections, and
facial pain. Protocol for the CIMDL diagnosis includes medical history, clinical examination, magnetic
resonance imaging, laboratory tests, immunology and serology tests, and chest x-ray. A 68-year-old
man presented with a brain extension mimicking an ischemic-like lesion with surrounding edema.
A diagnosis of CIMDL was made in the light of the patient’s medical history, imaging studies, and
laboratory testing including pANCA positivity which seems to promote disease phenotype.

Keywords

Cocaine; Anti-neutrophil cytoplasmic antibodies; Cocaine-induced midline destructive lesions

Hrčak ID:

328165

URI

https://hrcak.srce.hr/328165

Publication date:

31.10.2025.

Article data in other languages: croatian

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