Echevarria Victoria, Echevarria Alexandra C, Casadesus Damian
Internal Medicine, American University of the Caribbean, Sint Maarten, MAF.
Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Cureus. 2023 Sep 7;15(9):e44862. doi: 10.7759/cureus.44862. eCollection 2023 Sep.
The use of cocaine is associated with serious complications including coronary vasospasm and myocardial, renal, intestinal, and neurological ischemia. Among these feared complications lies limb ischemia which is a rare potential side effect of chronic cocaine use. We present the case of a 50-year-old female with an extensive history of cocaine use who developed ischemia in all four limbs. Imaging studies revealed pulmonary emboli, multisystem thromboses, and microhemorrhages in the brain. Laboratory studies were significant for leukocytosis, thrombocytopenia, schistocytes on blood smear, and normal rheumatologic and hematologic studies. The patient was diagnosed with cocaine-induced thrombotic microangiopathy and she was treated symptomatically and with continuous heparin infusion. However, she ultimately requested to be discharged home and was lost to follow-up. Cocaine-induced thrombotic microangiopathy has been reported in only a few other patients to date and although there are some theories describing the possible pathophysiology, a clearly defined explanation has not yet been widely accepted.
使用可卡因会引发严重并发症，包括冠状动脉痉挛以及心肌、肾脏、肠道和神经缺血。在这些令人担忧的并发症中，肢体缺血较为罕见，是长期使用可卡因的潜在副作用。我们报告一例50岁有大量可卡因使用史的女性，其四肢均出现缺血。影像学检查显示有肺栓塞、多系统血栓形成以及脑部微出血。实验室检查结果显示白细胞增多、血小板减少、血涂片出现裂细胞，而风湿和血液学检查正常。该患者被诊断为可卡因诱导的血栓性微血管病，接受了对症治疗并持续静脉输注肝素。然而，她最终要求出院回家，失访。迄今为止，仅有少数其他患者报告过可卡因诱导的血栓性微血管病，尽管有一些理论描述了可能的病理生理学，但尚未有明确定义的解释被广泛接受。
