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| {{Short description|A nasal condition associated with cocaine use}} | {{Short description|A nasal condition associated with cocaine use}} | ||
| {{Infobox medical condition | {{Infobox medical condition | ||
| | name = Cocaine-Induced Midline Destructive Lesions | | name = Cocaine-Induced Midline Destructive Lesions | ||
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| | frequency = 5% of cocaine users | | frequency = 5% of cocaine users | ||
| }} | }} | ||
| '''Cocaine-Induced Midline Destructive Lesions (CIMDL)''' is the progressive destruction of nasal architecture with the erosion of the ], ], and ] associated with prolonged ], colloquially 'snorting', of ].<ref>{{Cite journal | |
'''Cocaine-Induced Midline Destructive Lesions (CIMDL)''' is the progressive destruction of nasal architecture with the erosion of the ], ], and ]es associated with prolonged ], colloquially 'snorting', of ].<ref>{{Cite journal |last1=Di Cosola |first1=Michele |last2=Ambrosino |first2=Mariateresa |last3=Limongelli |first3=Luisa |last4=Favia |first4=Gianfranco |last5=Santarelli |first5=Andrea |last6=Cortelazzi |first6=Roberto |last7=Lo Muzio |first7=Lorenzo |date=2021-07-23 |title=Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis |journal=International Journal of Environmental Research and Public Health |language=en |volume=18 |issue=15 |pages=7831 |doi=10.3390/ijerph18157831 |doi-access=free |pmid=34360121 |pmc=8345435 |issn=1660-4601 }}</ref> The condition begins with erosion of mucusal lining and progress with damage to nasal cartilaginous and bony structures.<ref name="distribution">{{Cite journal |last1=Nitro |first1=Letizia |last2=Pipolo |first2=Carlotta |last3=Fadda |first3=Gian Luca |last4=Allevi |first4=Fabiana |last5=Borgione |first5=Mario |last6=Cavallo |first6=Giovanni |last7=Felisati |first7=Giovanni |last8=Saibene |first8=Alberto Maria |date=2022-07-01 |title=Distribution of cocaine-induced midline destructive lesions: systematic review and classification |journal=European Archives of Oto-Rhino-Laryngology |language=en |volume=279 |issue=7 |pages=3257–3267 |doi=10.1007/s00405-022-07290-1 |issn=1434-4726 |pmc=9130192 |pmid=35138441}}</ref> | ||
| CIMDL is also known colloquially as cocaine or '''coke nose'''.<ref name="distribution" /> | CIMDL is also known colloquially as cocaine or '''coke nose'''.<ref name="distribution" /> | ||
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| Patients with CIMDL present with chronic nasal obstruction, ], nose bleeding, and severe facial pain. More advanced cases present nasal septal perforation, diffuse necrotizing ulcerative lesions, nasal deformation, and palatal perforation.<ref name="distribution" /> | Patients with CIMDL present with chronic nasal obstruction, ], nose bleeding, and severe facial pain. More advanced cases present nasal septal perforation, diffuse necrotizing ulcerative lesions, nasal deformation, and palatal perforation.<ref name="distribution" /> | ||
| Due to its non-specific symptomatology, CIMDL is easily confused with other diseases such as infections, autoimmune, and granulomatous diseases<ref name=":1">{{Cite journal | |
Due to its non-specific symptomatology, CIMDL is easily confused with other diseases such as infections, autoimmune, and granulomatous diseases,<ref name=":1">{{Cite journal |last1=Trimarchi |first1=Matteo |last2=Miluzio |first2=Annarita |last3=Nicolai |first3=Piero |last4=Morassi |first4=Maria Laura |last5=Bussi |first5=Mario |last6=Marchisio |first6=Pier Carlo |date=2006-03-01 |title=Massive Apoptosis Erodes Nasal Mucosa of Cocaine Abusers |url=https://journals.sagepub.com/doi/abs/10.1177/194589240602000207 |journal=American Journal of Rhinology |language=en |volume=20 |issue=2 |pages=160–164 |doi=10.1177/194589240602000207 |issn=1050-6586}}</ref> albeit with some absent systemic symptoms such as fever, arthralgia, myalgia, CIMDL can be differentiated from systemic conditions.<ref name=":2" /> Other markers for CIMDL include perinuclear ](ANCA) and ] specific ANCA.<ref>{{Cite journal |last1=Di Cosola |first1=Michele |last2=Ambrosino |first2=Mariateresa |last3=Limongelli |first3=Luisa |last4=Favia |first4=Gianfranco |last5=Santarelli |first5=Andrea |last6=Cortelazzi |first6=Roberto |last7=Lo Muzio |first7=Lorenzo |date=January 2021 |title=Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis |journal=International Journal of Environmental Research and Public Health |language=en |volume=18 |issue=15 |pages=7831 |doi=10.3390/ijerph18157831 |doi-access=free |issn=1660-4601 |pmc=8345435 |pmid=34360121}}</ref> | ||
| ==Pathophysiology== | ==Pathophysiology== | ||
| Although not entirely understood, CIMDL is thought to be caused mainly by the vasoconstricting effects of cocaine, which induces ] and subsequent ] of the mucosal lining, followed by damage to nasal cartilaginous and bony structures.<ref name="distribution" /> 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.<ref name=":1" /> | Although not entirely understood, CIMDL is thought to be caused mainly by the vasoconstricting effects of cocaine, which induces ] and subsequent ] of the mucosal lining, followed by damage to nasal cartilaginous and bony structures.<ref name="distribution" /> 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.<ref name=":1" /> | ||
| 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.<ref name=":0">{{Cite journal | |
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.<ref name=":0">{{Cite journal |last1=Trimarchi |first1=M. |last2=Bussi |first2=M. |last3=Sinico |first3=R. A. |last4=Meroni |first4=Pierluigi |last5=Specks |first5=U. |date=February 2013 |title=Cocaine-induced midline destructive lesions - an autoimmune disease? |url=https://pubmed.ncbi.nlm.nih.gov/22940554/ |journal=Autoimmunity Reviews |volume=12 |issue=4 |pages=496–500 |doi=10.1016/j.autrev.2012.08.009 |issn=1873-0183 |pmid=22940554}}</ref> | ||
| 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.<ref name=":1" /> |
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.<ref name=":1" /> | ||
| ==Treatment== | ==Treatment== | ||
| 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.<ref name=":2">{{Cite journal | |
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.<ref name=":2">{{Cite journal |last1=Trimarchi |first1=Matteo |last2=Bertazzoni |first2=Giacomo |last3=Bussi |first3=M. |date=January 2014 |title=Cocaine induced midline destructive lesions |url=https://www.rhinologyjournal.com/Abstract.php?id=1190 |journal=Rhinology |volume=52 |issue=2}}</ref> | ||
| ==References== | ==References== | ||
| {{reflist}} | {{reflist}} | ||
| ] | |||
| ] | |||
Latest revision as of 17:34, 26 December 2024
A nasal condition associated with cocaine use Medical condition| 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. The condition begins with erosion of mucusal lining and progress with damage to nasal cartilaginous and bony structures.
CIMDL is also known colloquially as cocaine or coke nose.
Signs and symptoms
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.
Due to its non-specific symptomatology, CIMDL is easily confused with other diseases such as infections, autoimmune, and granulomatous diseases, albeit with some absent systemic symptoms such as fever, arthralgia, myalgia, CIMDL can be differentiated from systemic conditions. Other markers for CIMDL include perinuclear anti-neutrophil cytoplasmic antibody(ANCA) and neutrophil elastase specific ANCA.
Pathophysiology
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. 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.
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.
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.
Treatment
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.
References
- Di Cosola, Michele; Ambrosino, Mariateresa; Limongelli, Luisa; Favia, Gianfranco; Santarelli, Andrea; Cortelazzi, Roberto; Lo Muzio, Lorenzo (2021-07-23). "Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis". International Journal of Environmental Research and Public Health. 18 (15): 7831. doi:10.3390/ijerph18157831. ISSN 1660-4601. PMC 8345435. PMID 34360121.
- ^ Nitro, Letizia; Pipolo, Carlotta; Fadda, Gian Luca; Allevi, Fabiana; Borgione, Mario; Cavallo, Giovanni; Felisati, Giovanni; Saibene, Alberto Maria (2022-07-01). "Distribution of cocaine-induced midline destructive lesions: systematic review and classification". European Archives of Oto-Rhino-Laryngology. 279 (7): 3257–3267. doi:10.1007/s00405-022-07290-1. ISSN 1434-4726. PMC 9130192. PMID 35138441.
- ^ Trimarchi, Matteo; Miluzio, Annarita; Nicolai, Piero; Morassi, Maria Laura; Bussi, Mario; Marchisio, Pier Carlo (2006-03-01). "Massive Apoptosis Erodes Nasal Mucosa of Cocaine Abusers". American Journal of Rhinology. 20 (2): 160–164. doi:10.1177/194589240602000207. ISSN 1050-6586.
- ^ Trimarchi, Matteo; Bertazzoni, Giacomo; Bussi, M. (January 2014). "Cocaine induced midline destructive lesions". Rhinology. 52 (2).
- Di Cosola, Michele; Ambrosino, Mariateresa; Limongelli, Luisa; Favia, Gianfranco; Santarelli, Andrea; Cortelazzi, Roberto; Lo Muzio, Lorenzo (January 2021). "Cocaine-Induced Midline Destructive Lesions (CIMDL): A Real Challenge in Diagnosis". International Journal of Environmental Research and Public Health. 18 (15): 7831. doi:10.3390/ijerph18157831. ISSN 1660-4601. PMC 8345435. PMID 34360121.
- Trimarchi, M.; Bussi, M.; Sinico, R. A.; Meroni, Pierluigi; Specks, U. (February 2013). "Cocaine-induced midline destructive lesions - an autoimmune disease?". Autoimmunity Reviews. 12 (4): 496–500. doi:10.1016/j.autrev.2012.08.009. ISSN 1873-0183. PMID 22940554.