Clinical and Forensic Signs Related to Cocaine Abuse

Ricardo Jorge Dinis-Oliveira, Felix Carvalho, Jose Alberto Duarte, Jorge Brandao Proenca, Agostinho Santos, Teresa Magalhaes

Abstract

Good laboratory practice in toxicological analysis requires pre-analytical steps for collection of detailed information related to the suspected poisoning episodes, including biological and non-biological circumstantial evidences, which should be carefully scrutinized. This procedure provides great help to unveil the suspected cause of poisoning, to select the appropriate and correct samples to be analyzed and can facilitate the decision about the analytical techniques to perform. This implies a good knowledge of the signs related to acute and chronic intoxications by drugs of abuse. In this manuscript we highlight and discuss clinical and forensic imaging related to cocaine abuse, namely the midline destructive lesion, dental health, pseudoscleradermatous triad and crack hands, necrosis and gangrene of extremities and several other skin manifestations, reticular purpura, intracerebral and peripheral hemorrhages, angioneurotic edema, rhabdomyolysis, and crack lung. For this purpose, the state of the art on this topic is discussed, using clinical and forensic cases from our professional database in complement to images and mechanistic data from literature.

Keywords: Cocaine, midline destructive lesion, dental health, pseudoscleradermatous triad and “crack hands”, necrosis and gangrene of extremities, reticular purpura, intracerebral and peripheric hemorrhages, angioneurotic edema, rhabdomyolysis, “crack lung”, non biological evidences