Cutaneous manifestations of injectable drug use: hidden secrets

Cutis. 2014 Apr;93(4):185-7.

Abstract

Abscesses related to drug use are the most common cutaneous manifestations among injection drug users, often occurring when the veins become less accessible. In these cases, other techniques may be used to administer drugs, such as skin popping (subcutaneous injection) or muscle popping (intramuscular injection). The main risk factors for abscess formation include skin popping, use of unsterilized needles, and injection of speedball (a mixture of cocaine and heroin). We present a case of recurrent abscesses accompanied by fever, hypersomnia alternating with insomnia, diaphoresis, fatigue, recent weight loss, and agitation following subcutaneous injection of a tramadol, opipramol, and clonazepam mixture. Differential diagnoses included pyoderma gangrenosum on the basis of hepatitis C virus, skin lesions connected with human immunodeficiency virus infection, vasculitis, endocarditis, and serotonin syndrome. The patient was treated with oral antibiotics, surgical incision, and drainage of the abscesses, with consequent improvement.

Publication types

  • Case Reports

MeSH terms

  • Abscess / etiology*
  • Abscess / microbiology
  • Abscess / therapy
  • Clonazepam / administration & dosage
  • Clonazepam / adverse effects
  • Diagnosis, Differential
  • Humans
  • Male
  • Opipramol / administration & dosage
  • Opipramol / adverse effects
  • Recurrence
  • Risk Factors
  • Skin Diseases, Bacterial / etiology*
  • Skin Diseases, Bacterial / microbiology
  • Skin Diseases, Bacterial / therapy
  • Soft Tissue Infections / etiology*
  • Soft Tissue Infections / microbiology
  • Soft Tissue Infections / therapy
  • Substance Abuse, Intravenous / complications*
  • Tramadol / administration & dosage
  • Tramadol / adverse effects
  • Treatment Outcome
  • Young Adult

Substances

  • Tramadol
  • Clonazepam
  • Opipramol