Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Resident
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Internal Medicine
Academic Level (Author 6)
Faculty
Discipline Track
Clinical Science
Abstract
Introduction: Cocaine is a strong central nervous system stimulant that is highly addictive with a wide potential for abuse as a recreational drug. The use of cocaine in an estimated 3 million Texans and 560 million Americans, has led to a growing health care hazard with many detrimental effects. Physiologically, cocaine causes significant vasoconstriction often leading to venous occlusion with subsequent ulceration and necrosis of mucosal membranes. Although cocaine is typically abused by inhalation or intravenous routes, few cases of injection into the genital region have been reported as means of abuse, leading to priapism, vasculitis, and in some cases Fournier's gangrene. We present a rare case of a necrotic penile ulcer caused by cocaine.
Case Presentation: A 31-year-old male with a past medical history of uncontrolled diabetes mellitus type 2, and substance abuse presented to the Emergency room with complaints of severe pain and swelling at the site of a necrotic lesion on the penile shaft. The patient noted the lesion began as a small pruritic, pimple-like area which quickly progressed into a black scab like lesion. Upon presentation, the patient was mildly tachycardic with a heart rate of 103. Physical examination revealed an erythematous, tender, black necrotic ulcer as shown in figure 1. Laboratory values obtained were significant for leukocytosis, with white blood count of 13.33 thousand/ uL and hyperglycemia of 306mg/dl. The remaining labs were grossly unremarkable. Imaging with a CT of the abdomen and pelvis as well as an ultrasound of the penis were obtained, revealing mild swelling of the penile shaft with no evidence of Fournier's gangrene. Additional evaluation ruled out vasculitis, spider bites, and sexually transmitted disease. The patient was subsequently admitted for sepsis secondary to cellulitis of the penile shaft and was started on intravenous antibiotics. The patient was evaluated by infectious disease and urology, and upon further questioning, endorsed that his partner uses oral application of cocaine prior to oral sex, which he engaged in the night before his symptoms began. The patient was eventually transitioned to oral antibiotics with near total symptom resolution. Prior to discharge, he was counseled on cessation of drug abuse and advised of potential consequences of ongoing cocaine use.
Discussion: Sympathetic overactivity from cocaine manifests as tachycardia, dilated pupils, and intense vasoconstriction, which can cause mucosal necrosis and ulceration. Cocaine's rapid absorption through thin epithelium, which is more permeable than the skin's keratinized epithelium, is exploited by users who apply it topically to the penis to enhance absorption and sexual performance. Cocaine applied topically to the penis, particularly on the glans, can cause superficial necrosis due to intense vasoconstriction. This practice, though not well-known, can lead to superficial necrosis due to intensevasoconstriction. This case highlights the different areas that can be affected by cocaine and warrants careful history regarding drug usage in atypical genital lesions. Counseling of patients about life threatening complications related to cocaine abuse should be fortified.
Presentation Type
Poster
Recommended Citation
Kondapavuluru, Roy; Haj-yahya, Khairiya; Gonzalez, Elimar; Tran, Victor; Mifuji, Roque; and Rosas, Luis, "The Hidden Dangers of Cocaine: A Rare Case of Necrotic Penile Ulcer" (2024). Research Colloquium. 58.
https://scholarworks.utrgv.edu/colloquium/2024/posters/58
Included in
The Hidden Dangers of Cocaine: A Rare Case of Necrotic Penile Ulcer
Introduction: Cocaine is a strong central nervous system stimulant that is highly addictive with a wide potential for abuse as a recreational drug. The use of cocaine in an estimated 3 million Texans and 560 million Americans, has led to a growing health care hazard with many detrimental effects. Physiologically, cocaine causes significant vasoconstriction often leading to venous occlusion with subsequent ulceration and necrosis of mucosal membranes. Although cocaine is typically abused by inhalation or intravenous routes, few cases of injection into the genital region have been reported as means of abuse, leading to priapism, vasculitis, and in some cases Fournier's gangrene. We present a rare case of a necrotic penile ulcer caused by cocaine.
Case Presentation: A 31-year-old male with a past medical history of uncontrolled diabetes mellitus type 2, and substance abuse presented to the Emergency room with complaints of severe pain and swelling at the site of a necrotic lesion on the penile shaft. The patient noted the lesion began as a small pruritic, pimple-like area which quickly progressed into a black scab like lesion. Upon presentation, the patient was mildly tachycardic with a heart rate of 103. Physical examination revealed an erythematous, tender, black necrotic ulcer as shown in figure 1. Laboratory values obtained were significant for leukocytosis, with white blood count of 13.33 thousand/ uL and hyperglycemia of 306mg/dl. The remaining labs were grossly unremarkable. Imaging with a CT of the abdomen and pelvis as well as an ultrasound of the penis were obtained, revealing mild swelling of the penile shaft with no evidence of Fournier's gangrene. Additional evaluation ruled out vasculitis, spider bites, and sexually transmitted disease. The patient was subsequently admitted for sepsis secondary to cellulitis of the penile shaft and was started on intravenous antibiotics. The patient was evaluated by infectious disease and urology, and upon further questioning, endorsed that his partner uses oral application of cocaine prior to oral sex, which he engaged in the night before his symptoms began. The patient was eventually transitioned to oral antibiotics with near total symptom resolution. Prior to discharge, he was counseled on cessation of drug abuse and advised of potential consequences of ongoing cocaine use.
Discussion: Sympathetic overactivity from cocaine manifests as tachycardia, dilated pupils, and intense vasoconstriction, which can cause mucosal necrosis and ulceration. Cocaine's rapid absorption through thin epithelium, which is more permeable than the skin's keratinized epithelium, is exploited by users who apply it topically to the penis to enhance absorption and sexual performance. Cocaine applied topically to the penis, particularly on the glans, can cause superficial necrosis due to intense vasoconstriction. This practice, though not well-known, can lead to superficial necrosis due to intensevasoconstriction. This case highlights the different areas that can be affected by cocaine and warrants careful history regarding drug usage in atypical genital lesions. Counseling of patients about life threatening complications related to cocaine abuse should be fortified.