Sittel C, Eckel H E
University of Cologne, Department of Otorhinolaryngology/Head and Neck Surgery, Germany.
Eur Arch Otorhinolaryngol. 1998;255(9):446-7. doi: 10.1007/s004050050096.
We describe a 36-year-old patient with an aggressive, midline intranasal and naso- and oropharyngeal destructive process. For months the patient denied heavy abuse of nasal cocaine, but finally admitted it. Necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, nasal septal as well as hard palate perforation were observed clinically. Repeated biopsies revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. Since serum was slightly positive for antineutrophil cytoplasmic antibody, the initial diagnosis was Wegener's granulomatosis. In the United States there have been a few reports on a new cocaine-associated syndrome presenting as an aggressive, midline, intranasal and intrapharyngeal destructive process mimicking limited Wegener's granulomatosis and midline reticulosis. We report the first such case in Europe and offer guidelines for the diagnostic work-up of such cases.
我们描述了一名36岁的患者，其患有侵袭性的、位于中线的鼻内以及鼻咽和口咽破坏性病变。数月来，该患者否认大量滥用鼻用可卡因，但最终承认了此事。临床上观察到双侧下鼻甲和中鼻甲坏死及萎缩、明显的鼻咽和口咽溃疡、鼻中隔以及硬腭穿孔。多次活检显示有慢性炎症和坏死的局灶性区域，但没有血管炎或肉芽肿形成的证据。由于抗中性粒细胞胞浆抗体血清呈弱阳性，最初诊断为韦格纳肉芽肿。在美国，有几篇关于一种新的可卡因相关综合征的报道，该综合征表现为侵袭性的、位于中线的鼻内和咽内破坏性病变，类似于局限性韦格纳肉芽肿和中线网状细胞增多症。我们报告了欧洲首例此类病例，并为此类病例的诊断检查提供指导原则。
