Case Reports of Heroin Injection Site Necrosis: A Novel Antecedent of Nicolau Syndrome

Brandon Rose; Thomas G Powell; Michelle Jones; Shawn A Chillag; Suzanne Kemper

doi:10.7759/cureus.29235

Case Reports of Heroin Injection Site Necrosis: A Novel Antecedent of Nicolau Syndrome

Cureus. 2022 Sep 16;14(9):e29235. doi: 10.7759/cureus.29235. eCollection 2022 Sep.

Authors

Brandon Rose¹, Thomas G Powell², Michelle Jones³, Shawn A Chillag⁴, Suzanne Kemper⁵

Affiliations

¹ Internal Medicine, Baptist Health Medical Group, Kentucky, USA.
² Transitional Year, Conway Medical Center, Conway, USA.
³ Pulmonary-Critical Care, Prisma Health, Greenville, USA.
⁴ Internal Medicine, West Virginia University School of Medicine, Charleston, USA.
⁵ Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, USA.

Abstract

Heroin injection-site necrosis (HISN) is a novel and poorly understood complication of intravenous drug abuse (IVDA). We present three cases of HISN that were evaluated and treated in Charleston, West Virginia, in 2019 and 2020. The documented cases show similarities involving patient care, follow-up, clinical progression, patient demographic, and dermatologic sequelae. We discuss these similarities, provide clinical recommendations, review proposed etiologies of HISN, and introduce Nicolau syndrome as a potential mechanism.

Keywords: adulterated heroin; clinical case report; heroin injection complication; livedoid dermatitis; necrotizing fasciitis; nicolau syndrome; opioid-abuse; skin necrosis; drug abuse.

Publication types

Case Reports