Diagnosis: Cocaine-induced midline destructive lesions.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
Histologic examination of the biopsy specimen revealed a large ulcerated lesion with a dense inflammatory infiltrate. A predominantly neutrophilic component was present in superficial areas, whereas mostly small, nonatypical, mononuclear lymphocytic cells were found in the deep periadnexal component. No significant numbers of plasma cells or macrophages were present. No evidence of vasculitis or neoplastic growth was found (Figure 2).
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The results of serologic examinations were negative. Bacteriologic cultures yielded Staphylococcus aureus. Cultures were negative for fungi and mycobacteria. A urine sample was positive for cocaine. One week later, a wide perforation occurred in the anterior aspect of the soft palate. A chest x-ray film showed no abnormalities. Cutaneous lesions progressively resolved after the patient stopped using cocaine and nasal drops and began treatment with mupirocin ointment and oral amoxicillin–clavulanate potassium (Augmentin). The palatal perforation required a removable obturator before definitive restoration surgery.
DISCUSSION
The major . . . [Full Text of this Article]
