Cocaine-induced midline destruction. Issue 2 (15th February 2021)

• Record Type: Journal Article
• Authors: Ide, Veerle; Henckaerts, Liesbet; Vanbrabant, Peter; Vanderschueren, Steven
• Is Part Of: Oxford medical case reports. Volume 2021:Issue 2(2021)
• Publication Date: 2021-02-15
• Subjects: Emergency medicine -- Radiology -- Nuclear medicine and medical imaging -- Rheumatology -- Substance abuse -- Audiovestibular Medicine; Clinical medicine -- Case studies -- Periodicals; 616.09
• DOI: 10.1093/omcr/omaa135
• Languages: English
• ISSNs: 2053-8855

Abstract

ABSTRACT: In patients presenting with nasal septum perforation, the differential diagnosis between ANCA-associated vasculitis and cocaine-induced midline destruction (CIMD) can be challenging. We describe the case of a 28-year old man who presented with a nasal septum perforation. He admitted the use of cocaine and showed no other symptoms of systemic inflammation. Perinuclear anti-neutrophilic cytoplasmatic antibodies (p-ANCAs) came back positive, as did anti-proteinase 3-antibodies. Further testing revealed antibodies to human neutrophil elastase (HNE), typically found in CIMD but rarely in ANCA-associated vasculitis. The combination of an atypical ANCA-pattern and the detection of HNE-antibodies led to the diagnosis of CIMD. In conclusion, HNE antibodies can be used to distinguish between CIMD and ANCA-associated vasculitis.