Opioid‐related xylazine toxicity manifesting as myonecrosis, rhabdomyolysis, multifocal ischemic cerebral infarcts, and cerebral edema

Author:

Nwodim Ogechi1ORCID,Karsalia Ritesh2,Heslin Mark E.3,Lieberman Allyson E.3,Wang Sally Zehui4,Kalanuria Atul A.4,Elser Holly C.5,Driessen Bernd6,Caruso Christopher7,Anesi George L.7

Affiliation:

1. Department of Emergency Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

2. University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

3. Department of Medicine University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

4. Division of Neurocritical Care Department of Neurology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

5. Department of Neurology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

6. Department of Clinical Studies University of Pennsylvania School of Veterinary Medicine Kennett Square Pennsylvania USA

7. Division of Pulmonary, Allergy, and Critical Care University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

Abstract

AbstractThis article provides a report of a case of organ dysfunction, myonecrosis, rhabdomyolysis, multifocal ischemic cerebral infarcts, and cerebral edema after a patient's use of xylazine and fentanyl. Within the US opioid epidemic, xylazine is emerging as a troubling national sub‐story. The prevalence of xylazine within illicitly manufactured opioids and the proportion of opioid‐involved overdose deaths with detected xylazine are rising dramatically, the latter increasing 276% between 2019 and 2022. A 27‐year‐old woman with opioid use disorder, active intravenous drug use, and prior bacteremia presented to our institution's emergency department (ED) with left lower extremity pain and associated weakness, new acute bilateral hearing loss, multiple electrolyte derangements, and cerebral infarcts followed by cerebral edema, leading to an emergent sub‐occipital decompressive craniectomy and placement of an external ventricular drain. A definitive mechanism was not determined; however, we hypothesized that xylazine toxicity played a role in her clinical presentation, which could have future clinical implications, including the possibility to incorporate xylazine as part of toxicology screens.

Funder

National Institutes of Health

Perelman School of Medicine, University of Pennsylvania

Publisher

Wiley

Reference16 articles.

1. Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA

2. Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

3. Office of National Drug Control and Policy.Biden‐⁠Harris administration designates fentanyl combined with xylazine as an emerging threat to the United States. 2023. Accessed April 5 2024.https://www.whitehouse.gov/ondcp/briefing‐room/2023/04/12/biden‐harris‐administration‐designates‐fentanyl‐combined‐with‐xylazine‐as‐an‐emerging‐threat‐to‐the‐united‐states

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