Buprenorphine abuse
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Buprenorphine abuse Morphoea on the lower extremities and right dorsal hand and subcutaneous nodules on the bilateral upper and lower extremities following buprenorphine abuse: 2 case report
In a case series, a 29-year-old woman developed morphoea on the lower extremities and right dorsal hand following buprenorphine abuse, and a 37-year-old man multiple, painful, subcutaneous nodules on the bilateral upper and lower extremities following buprenorphine abuse [dosages, durations of treatments to reactions onset and outcomes not stated]. A 29-year-old woman, who had type 1 diabetes mellitus and dialysis-dependent chronic kidney disease, presented with a longstanding history of indurated, hyperpigmented plaques on the lower extremities and right dorsal hand. The clinical differential diagnosis was nephrogenic systemic fibrosis or morphea. A punch biopsy of her right hand lesion revealed dermal sclerosis with decreased CD34 immunostaining, consistent with morphea, along with intravascular foreign material. The foreign material was nonpolarizable, basophilic and coral shaped. It appeared red by mucicarmine and Congo red stains, dark blue by periodic acid-Schiff stain and black by Fontana Masson stain. Despite its resemblance to calcium, the material was negative with Von Kossa stain. The morphologic and staining patterns were consistent with crospovidone. She had a known history of polysubstance abuse, including opioid dependence managed with sublingual buprenorphine tablets. Crospovidone is a pharmaceutical excipient found in a variety of tablets that may be illicitly crushed and injected, including the sublingual buprenorphine tablets. As a result, a diagnosis of morphea on the lower extremities and right dorsal hand following abuse of buprenorphine (i.e. following subcutaneous injection of crushed sublingual buprenorphine tablets) was made. A 37-year-old man, who had a history of recurrent testicular seminoma, presented with the recent onset of multiple, painful, subcutaneous nodules on the bilateral upper and lower extremities concerning for metastatic disease. A punch biopsy of the left forearm lesion showed a deep dermal abscess containing mixed inflammation admixed with similar foreign material and apparent starch particles. The foreign material was nonpolarisable, basophilic and coral shaped. It appeared red by mucicarmine and Congo red stains, dark blue by periodic acid-Schiff stain and black by Fontana Masson stain. Despite its resemblance to calcium, the material was negative with Von Kossa stain. The morphologic and staining patterns were consistent with crospovidone. He had a known history of polysubstance abuse, including opioid dependence managed with sublingual buprenorphine tablets. Crospovidone is a pharmaceutical excipient found in a variety of tablets that may be illicitly crushed and injected, including the sublingual buprenorphine tablets. As a result, a diagnosis of subcutaneous nodules on the bilateral upper and lower extremities following abuse of buprenorphine (i.e. following subcutaneous
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