Cocaine-induced midline destructive lesion

Abstract

Conflict of interest: none declared. Cocaine‐induced midline destructive lesion (CIMDL) is the term used to describe destruction of the osteocartilaginous structures of the nose, sinuses and palate caused by cocaine inhalation. The clinical appearance may mimic a vasculitis but it lacks the typical histopathological findings of a true vasculitis. This condition is often overlooked in clinical practice particularly if a history of cocaine inhalation is not sought or volunteered. It is vital to recognize this clinical condition to prevent immunosuppressive therapy being prescribed for a presumed vasculitis. A 29‐year‐old man was referred from the ear, nose and throat department with an 8‐week history of nasal swelling and ulceration associated with an episode of severe epistaxis (Fig. 1). He gave a 3‐year history of cocaine inhalation. Before his presentation, he had increased the frequency of his cocaine use. He was otherwise well, on no regular medication and had no family history of skin, sinus or joint disease.