Cutaneous complications after intra-arterial injection of buprenorphine, which is used as oral maintenance treatment for patients with opioid dependence, are rare. We describe 2 patients whose drug abuse was suspected owing to necrotic livedo confirmed by histopathologic findings that showed strong periodic acid–Schiff (PAS) staining in Maltese cross–shaped bodies.
Clinical and histopathologic images from case 1. Purpuric and necrotic lesions of the left leg (A) and livedoid lesions of the left arm (B). C, Histopathologic slide showing foreign bodies with a refringent Maltese cross pattern under polarized light (hematoxylin-eosin, original magnification ×400).
Clinical and histopathologic images from case 2. A, Purpuric and infiltrated livedoid lesions of the left arm. B, Histopathologic slide showing corn starch presenting as refringent foreign bodies with a typical Maltese cross pattern under polarized light (hematoxylin-eosin, original magnification ×400). Linear refringent areas represent normal dermal collagen bundles.
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