Dănescu Ilenuţa 1, Voicu V. A. 2, Caragea Genica 3, Macovei R. 1, 4, Ionică M. 5
1 ICU II Toxicology, Clinical Emergency Hospital Bucharest
2 Romanian Academy
3 Military Medical Research Center
4 University of Medicine and Pharmacy “Carol Davila”
5 University “Politehnica” Bucharest, Optoelectronic Research Center
Abstract
Vascular injection resulting from abuse of drugs can cause rhabdomyolysis and limb ischemia along with other systemic complications. Methadone tablets contain microcrystalline cellulose, which has been shown to cause gangrene in animal studies. We present the case of an injection with methadone tablets dissolved in water, followed by usual complications of methadone overdose doubled by unusual effects: sudden sensorineural hearing loss, compartment syndrome of the upper left limb with rhabdomyolysis and renal failure with preserved diuresis, liver cytolysis. A 36-year-old male, in substitution therapy with 60 mg/day of methadone for 3 years was admitted 12 hours after voluntary intravenous administration of 160 mg methadone with altered mental status, bilateral hearing loss, tachycardia, swelling, and edema at the puncture site. Toxicological urine gas chromatography/mass spectrometry (GS/MS) testing: methadone. Laboratory data revealed an increase in creatinine kinase, myoglobin, renal and hepatic dysfunction. Plastic surgery evaluation: compartment syndrome of left hand. Audiometry testing performed at 24 hours: loss of -36 dB right ear and -52 dB left ear. The hearing loss completely resolved within 4 days. This patient responded to medical therapy combined with local treatment. He was discharged after 30 days in good clinical condition.