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- Title
A mimic of soft tissue infection: intra-arterial injection drug use producing hand swelling and digital ischemia.
- Authors
Foster, Sean D.; Lyons, Michael S.; Runyan, Christopher M.; Otten, Edward J.
- Abstract
BACKGROUND: Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be diffi cult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed. METHODS: A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated fi ndings consistent with digital ischemia of embolic etiology. RESULTS: As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit. CONCLUSION: Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a defi nite history of injection drug use.
- Subjects
DRUG utilization; SUBSTANCE abuse; ISCHEMIA treatment; COMPARTMENT syndrome; ERYTHEMA
- Publication
World Journal of Emergency Medicine, 2015, Vol 6, Issue 3, p233
- ISSN
1920-8642
- Publication type
Article
- DOI
10.5847/wjem.j.1920-8642.2015.03.014