Oro-Naso-Sino-Orbital-Cutaneous Fistula From Prolonged Cocaine Use.

S Boyle, M Hussain, C Kirby, S Brennan, L Clarke, R Mullan, D Halpenny, N Conlon, M A Little, B J Conlon, S Abdulrahman

Irish medical journal 2022 Feb 17

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Presentation We present the case of a 48-year-old man with nasal cellulitis and subsequent oro-naso-sino-orbital-cutaneous fistula from prolonged cocaine use. Diagnosis Initial laboratory investigations reported a raised white cell count (WBC) and C-Reactive Protein (CRP) and subsequently a positive atypical anti-neutrophil cytoplasm antibodies (ANCA) and positive anti-proteinase (PR3). Perihilar lung nodularity on chest imaging raised the possibility of a systemic autoimmune response. His urinalysis was positive for cocaine. Treatment He was commenced on Augmentin, Amphotericin B and Prednisolone. An obturator was created to manage the oro-nasal fistula. A subsequent naso-cutaneous defect was re-approximated. Daily nasal saline douche and abstinence of cocaine were recommended. Discussion Cocaine use in the community is rising and poses a challenge to multiple facets of our health care system.

Citation

S Boyle, M Hussain, C Kirby, S Brennan, L Clarke, R Mullan, D Halpenny, N Conlon, M A Little, B J Conlon, S Abdulrahman. Oro-Naso-Sino-Orbital-Cutaneous Fistula From Prolonged Cocaine Use. Irish medical journal. 2022 Feb 17;115(2):544