Cocaine-induced periostitis and vasculopathy

Cocaine-induced periostitis and vasculopathy Veronika K. Jaeger et al. ulcer disease secondary to systemic sclerosis registered 38 Loos-Ayav C, Chau N, Riani C, Guillemin F. Functional in the EUSTAR database. Clin Exp Rheumatol 2015;33(4 disability in France and its relationship with health-related Suppl 91):S4754. quality of life  a population-based prevalence study. Clin Exp Rheumatol 2007;25:7018. 36 Lo ´ ra ´ nd V, Czirja ´ k L, Minier T. Musculoskeletal involve- ment in systemic sclerosis. Presse Med 39 Oude Voshaar MAH, ten Klooster PM, Taal E et al. 2014;43:e31528. Linking physical function outcomes in rheumatology: 37 Bassel M, Hudson M, Taillefer SS et al. Frequency and Performance of a Crosswalk for Converting Health impact of symptoms experienced by patients with sys- Assessment Questionnaire Scores to Short Form 36 temic sclerosis: results from a Canadian National Survey. Physical Functioning Scale Scores. Arthritis Care Res Rheumatology 2011;50:7627. 2014;66:17548. Rheumatology 2018;57:450 doi:10.1093/rheumatology/kex297 Clinical vignette Advance Access publication 9 August 2017 in other systemic vasculitides [2]. However, it may also be the result of exposure to the cocaine adulterant A 46-year-old male patient with ongoing history of levamisole, as we know about the possible occurrence cocaine abuse presented with bilateral pain in the anterior of periostitis with prolonged antifungal treatment with thigh. The patient’s skin, spine and joints were normal. voriconazole (an imidazole like levamisole). The muscles of the thigh displayed normal force and no tenderness on palpation. Blood work showed elevated Funding: No specific funding was received from any ESR (46 mm/h), CRP [168 mg/l (normal <5 mg/l], and cre- bodies in the public, commercial or not-for-profit sectors atine phosphokinase [352 U/l (normal <190 U/l)]. to carry out the work described in this article. Leucocytes and granulocytes were slightly elevated. Urinalysis showed a non-glomerular microhaematuria Disclosure statement: The authors have declared no (Fig. 1). conflicts of interest. The MRI of both thighs detected a circular bilateral peri- 1 1 ostitis. The visceral angiogram showed a vasculopathy of Ralph Melzer and Lukas Schmid the small and very small vessels of the spleen and liver Rheumatology, Luzerner Kantonsspital, Lucerne, Switzerland and bilateral partial kidney infarction. There were no micro- aneurisms. Chest radiographs and echocardiography were Correspondence to: Ralph Melzer, Rheumatology, Luzerner normal and ANCA was negative. We made the diagnosis Kantonsspital, Spitalstrasse, 6000 Lucerne, Switzerland. of cocaine-induced periostitis and small-vessel vasculopathy E-mail: ralph.melzer@luks.ch and the patient was started on oral corticosteroids (50 mg/day) and acetic acid 100 mg/day, which led to rapid improvement. References Cocaine is well known to be able to induce vasculitic 1 Graf J. Rheumatic manifestations of cocaine use. Curr reactions, resembling idiopathic granulomatosis with Opin Rheumatol 2013;25:505. polyangiitis, sometimes including positive ANCA. In con- trast, a non-inflammatory syndrome with vasoconstric- 2Pe ´ richon S, Pagnoux C, Seror R et al. Periostitis in sys- tion, arterial stenoses and aneurisms is also known [1]. temic necrotizing vasculitides: study of the 4 cases iden- The periostitis in our patient may be a sign of cocaine- tified among 1762 patients of the FVSG database and induced vasculitis, as periostitis has been described rarely review of the literature. Presse Med 2010;39:16573. FIG.1 Gadolinium-enhanced, T1-weighted, fat-saturated MRI Bilateral circumferential periostitis (arrows) of the femoral diaphysis in the transverse and frontal planes. The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 450 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/3/450/4079918 by Ed 'DeepDyve' Gillespie user on 22 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Cocaine-induced periostitis and vasculopathy

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1462-0324
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Abstract

Veronika K. Jaeger et al. ulcer disease secondary to systemic sclerosis registered 38 Loos-Ayav C, Chau N, Riani C, Guillemin F. Functional in the EUSTAR database. Clin Exp Rheumatol 2015;33(4 disability in France and its relationship with health-related Suppl 91):S4754. quality of life  a population-based prevalence study. Clin Exp Rheumatol 2007;25:7018. 36 Lo ´ ra ´ nd V, Czirja ´ k L, Minier T. Musculoskeletal involve- ment in systemic sclerosis. Presse Med 39 Oude Voshaar MAH, ten Klooster PM, Taal E et al. 2014;43:e31528. Linking physical function outcomes in rheumatology: 37 Bassel M, Hudson M, Taillefer SS et al. Frequency and Performance of a Crosswalk for Converting Health impact of symptoms experienced by patients with sys- Assessment Questionnaire Scores to Short Form 36 temic sclerosis: results from a Canadian National Survey. Physical Functioning Scale Scores. Arthritis Care Res Rheumatology 2011;50:7627. 2014;66:17548. Rheumatology 2018;57:450 doi:10.1093/rheumatology/kex297 Clinical vignette Advance Access publication 9 August 2017 in other systemic vasculitides [2]. However, it may also be the result of exposure to the cocaine adulterant A 46-year-old male patient with ongoing history of levamisole, as we know about the possible occurrence cocaine abuse presented with bilateral pain in the anterior of periostitis with prolonged antifungal treatment with thigh. The patient’s skin, spine and joints were normal. voriconazole (an imidazole like levamisole). The muscles of the thigh displayed normal force and no tenderness on palpation. Blood work showed elevated Funding: No specific funding was received from any ESR (46 mm/h), CRP [168 mg/l (normal <5 mg/l], and cre- bodies in the public, commercial or not-for-profit sectors atine phosphokinase [352 U/l (normal <190 U/l)]. to carry out the work described in this article. Leucocytes and granulocytes were slightly elevated. Urinalysis showed a non-glomerular microhaematuria Disclosure statement: The authors have declared no (Fig. 1). conflicts of interest. The MRI of both thighs detected a circular bilateral peri- 1 1 ostitis. The visceral angiogram showed a vasculopathy of Ralph Melzer and Lukas Schmid the small and very small vessels of the spleen and liver Rheumatology, Luzerner Kantonsspital, Lucerne, Switzerland and bilateral partial kidney infarction. There were no micro- aneurisms. Chest radiographs and echocardiography were Correspondence to: Ralph Melzer, Rheumatology, Luzerner normal and ANCA was negative. We made the diagnosis Kantonsspital, Spitalstrasse, 6000 Lucerne, Switzerland. of cocaine-induced periostitis and small-vessel vasculopathy E-mail: ralph.melzer@luks.ch and the patient was started on oral corticosteroids (50 mg/day) and acetic acid 100 mg/day, which led to rapid improvement. References Cocaine is well known to be able to induce vasculitic 1 Graf J. Rheumatic manifestations of cocaine use. Curr reactions, resembling idiopathic granulomatosis with Opin Rheumatol 2013;25:505. polyangiitis, sometimes including positive ANCA. In con- trast, a non-inflammatory syndrome with vasoconstric- 2Pe ´ richon S, Pagnoux C, Seror R et al. Periostitis in sys- tion, arterial stenoses and aneurisms is also known [1]. temic necrotizing vasculitides: study of the 4 cases iden- The periostitis in our patient may be a sign of cocaine- tified among 1762 patients of the FVSG database and induced vasculitis, as periostitis has been described rarely review of the literature. Presse Med 2010;39:16573. FIG.1 Gadolinium-enhanced, T1-weighted, fat-saturated MRI Bilateral circumferential periostitis (arrows) of the femoral diaphysis in the transverse and frontal planes. The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com 450 https://academic.oup.com/rheumatology Downloaded from https://academic.oup.com/rheumatology/article-abstract/57/3/450/4079918 by Ed 'DeepDyve' Gillespie user on 22 March 2018

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RheumatologyOxford University Press

Published: Mar 1, 2018

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