COCAINE-INDUCED MIDLINE DESTRUCTIVE LESION WITH NASAL AND ORAL INVOLVEMENT: A CASE REPORT

Abstract

A 28-year-old homeless man presented with 1-year history of weight loss, nasal turbinate, oral mucosal inflammation, and septum necrosis. Physical examination revealed odynophagia, otalgia, high fever, and perforation of the hard palate involving extensive destruction of the soft palate and oropharynx. The patient confirmed regular cocaine use of at least 2 years. Laboratory testing showed leukocytosis, HIV and Venereal Disease Research Laboratory test nonreactive, and culture-tissue positive for fungus. Computed tomography of the oral cavity revealed expansive, infiltrative, heterogeneous, and irregular formation involving rhinopharynx and nasal fossa associated with the destruction of inferior and middle turbinates, nasal septum, and middle maxillary sinus wall. Histopathologic examination of the soft palate and pharynx indicated ulceration, extensive necrosis, and acute inflammatory infiltrate without atypia, granuloma, or vasculitis. Excluding the hypotheses of granulomatous inflammation and neoplasia, the cocaine-induced midline destructive lesions diagnosis was recognized. The patient was referred to an otorhinolaryngologist and buccomaxillofacial surgeon for management and follow-up. A 28-year-old homeless man presented with 1-year history of weight loss, nasal turbinate, oral mucosal inflammation, and septum necrosis. Physical examination revealed odynophagia, otalgia, high fever, and perforation of the hard palate involving extensive destruction of the soft palate and oropharynx. The patient confirmed regular cocaine use of at least 2 years. Laboratory testing showed leukocytosis, HIV and Venereal Disease Research Laboratory test nonreactive, and culture-tissue positive for fungus. Computed tomography of the oral cavity revealed expansive, infiltrative, heterogeneous, and irregular formation involving rhinopharynx and nasal fossa associated with the destruction of inferior and middle turbinates, nasal septum, and middle maxillary sinus wall. Histopathologic examination of the soft palate and pharynx indicated ulceration, extensive necrosis, and acute inflammatory infiltrate without atypia, granuloma, or vasculitis. Excluding the hypotheses of granulomatous inflammation and neoplasia, the cocaine-induced midline destructive lesions diagnosis was recognized. The patient was referred to an otorhinolaryngologist and buccomaxillofacial surgeon for management and follow-up.