Nasal Septum Perforation due to Cocaine Abuse

Abstract


Introduction
Cocaine is an alkaloid, which was originally used by South American Indians as a stimulant.It was introduced to medicine by Köller in the 1880s as a local anaesthetic.More recently, its stimulant effects have led to its use as a recreational drug resulting in social, economic and physical harm [1].
Differences in the effect of cocaine based on the route of administration have been an interest of researchers and clinicians for the past few decades.Intranasal administration of the powder form of cocaine (cocaine hydrochloride) was most popular [2].
Perforation of the nasal septum is an uncommon condition; Classically, this type of necrosis has been linked to cocaine intranasal use [3].When it occurs, its cause is most often idiopathic or traumatic.Nasal septum perforation may also be the presenting sign of drug addiction or a potentially life-threatening or serious systemic illness, even in an asymptomatic patient [1,[4][5][6][7].In this article, we describe a case of nasal septal perforation secondary to cocaine intranasal abuse.We also briefly review other common causes of perforation of the nasal septum.

Case Report
A 56-year-old man presented with nasal congestion, and nasal obstruction.The symptoms were reported to have started only 5 months earlier.he gave a ten years history of nasal cocaine usage, initially at a frequency of two to three times a month but developing into a daily habit.

Discussion
Intranasal drug abuse appears to be a growing trend.In addition to cocaine, insufflation of heroin and other opioids, stimulants, benzodiazepines, has been reported [8-10].Among heroin abusers, insufflation has become a popular method of drug administration, with rates of injection of heroin declining dramatically [11,12].This shift toward intranasal administration may be due in part to increasing awareness of HIV among drug abusers [13,14].
The patient reported that he had always snorted through the right nostril.There was no history of trauma and no somatic or psychiatric troubles.
In an endoscopic examination a large septal perforation accompanied by excessive necrotic tissues in the nasal space was obvious (Figure 1 and 2).
On examination her nasal cavities were filled with necrotic debris and extremely sensitive to touch, no deformity in the form of nose was observed.The soft palate, hard palate, tonsils and posterior oropharyngeal wall were normal.
A CT scan of the paranasal sinus showed necrosis of the nasal septum (Figure 3).
Multiple biopsies of the nose and palate were taken and showed necrosis and ulceration with signs of inflammation but no evidence for vacuities or granulomatosis.Erosion of the soft palate and nasal turbinates are more recently reported complications of intranasal prescription narcotic abuse [15].

Figure 1 and 2 :
Figure 1 and 2: Endoscopic view of the patient's nasal cavity