Cocaine-induced midline destructive lesions

Prolonged cocaine inhalation can cause destruction of nasal mucosa and ethmoidsinuses and palate perforation, thus inducing cocaine-induced midline destructive lesions (CIMDL)that affect only a limited number of predisposed patients. CIMDL are an autoimmune necrotizinginflammatory phenomenon associated with the presence of atypical antineutrophil cytoplasmicantibody (ANCA). Patients complain of epistaxis, nasal obstruction, hyposmia, sinus infections, andfacial pain. Protocol for the CIMDL diagnosis includes medical history, clinical examination, magneticresonance imaging, laboratory tests, immunology and serology tests, and chest x-ray. A 68-year-oldman presented with a brain extension mimicking an ischemic-like lesion with surrounding edema.A diagnosis of CIMDL was made in the light of the patient’s medical history, imaging studies, andlaboratory testing including pANCA positivity which seems to promote disease phenotype.