Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence

BMJ Case Rep. 2019 Mar 31;12(3):e228335. doi: 10.1136/bcr-2018-228335.

Abstract

Heroin-related myelopathy is an uncommon but often devastating complication of heroin intake. It is usually reported in individuals exposed to intravenous heroin after a variable drug-free period, leading to acute and complete spinal cord injury with poor long-term outcome. We describe an original case of acute longitudinally extensive transverse myelopathy following single heroin and cocaine intravenous exposure after a long period of abstinence confirmed by toxicological hair and retrospective urine drug analysis. This case could provide new insights in the understanding of this rare neurological complication.

Keywords: drug misuse (including addiction); neuroimaging; spinal cord.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Cocaine / administration & dosage*
  • Cocaine / adverse effects
  • Extinction, Psychological
  • Fecal Incontinence / etiology
  • Fecal Incontinence / physiopathology*
  • Female
  • Hair / chemistry*
  • Heroin / administration & dosage
  • Heroin / adverse effects*
  • Humans
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Myelitis, Transverse / complications
  • Myelitis, Transverse / diagnosis*
  • Myelitis, Transverse / physiopathology
  • Myelitis, Transverse / therapy
  • Paraplegia / etiology
  • Paraplegia / physiopathology*
  • Severity of Illness Index
  • Spinal Puncture
  • Substance Abuse Detection / methods
  • Substance Abuse, Intravenous / complications*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Heroin
  • Cocaine
  • Methylprednisolone