Abstract Listings 2024

Purpose

A 51-year-old patient presented with eyelid swelling, non-closure of the eyes, decreased vision and purulent secretion of both eyes.
For several years, he had used cocaine weekly. 20 years ago chronic destructive inflammation in the oral cavity began in the form of pyoderma gangrenosum, which led to significant tissue loss.
Vis OD=0.1 after 3 months – pr.lucis certae
Vis OS=0,63
Bilateral lagophthalmos of 8 mm, medial ectropion, loss of medial angle tissues with complete separation of the lacrimal ducts and free access to the nasal cavity, saddle nose, total corneal ulcer with hypopion without vitreous involvement right, keratitis with stromal infiltrate d=4mm left.

Methods

MRI shows complete destruction of the nasal cavity and all paranasal sinuses, destruction of os palatinum left and os lacrimalis bilateral with paranasal soft tissue defects. Pharyngeal biopsy showed nonspecific granulomatous inflammation without malignancy. A blood test detected cANCA.
He was admitted to the hospital for general and local antibiotic therapy.
Anterior chamber was irrigated with Vancomycin and Ceftazidime, a complete upper blepharotomy was surgically performed, which reduced the lagophthalmos to 6mm and the obturator closed the palate.

Results

As a result of clinical and laboratory data, a diagnosis of cocaine-induced vasculitis with midface destruction and eye involvement was established and treatment was prescribed: prednisone 80 mg daily and rituximab for 4 weeks until the test results improved.

Conclusion

Cocaine is an immunomodulator and can cause autoimmune reactions in the form of granulomatosis with polyangiitis locally with midface lesionen. The autoimmune reaction is laboratory-confirmed by the detection of cANCA. This ophthalmologically rare clinical picture underlines the importance of the social anamnesis, especially with regard to potential abuse.

Additional Authors

↑ Back to top