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Correspondence |

Livedoid and Necrotic Skin Lesions Due to Intra-arterial Buprenorphine Injections Evidenced by Maltese Cross–Shaped Histologic Bodies

Pierre Schneider, MD; Tu-Anh Duong, MD; Nicolas Ortonne, MD, PhD; Martine Bagot, MD, PhD; Jean-David Bouaziz, MD, PhD
Arch Dermatol. 2010;146(2):208-209. doi:10.1001/archdermatol.2009.372.
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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.

Del Giudice  P Cutaneous complications of intravenous drug abuse. Br J Dermatol 2004;150 (1) 1- 10
PubMed
Potier  ALeclech  CCroue  AChappard  DVerret  JL Necrotic livedo after injection of buprenorphine (Subutex) [in French]. Ann Dermatol Venereol 2007;134 (2) 148- 150
PubMed
Pierre-Alexandre  JFrançois  PAbdellah  S  et al.  An unusual case of livedoid and necrotic lesions in a drug addict. Am J Dermatopathol 2007;29 (1) 72- 74
PubMed
Del Giudice  PVandenbos  FBoissy  C  et al.  Cutaneous complications of direct intra-arterial injections in drug addicts. Acta Derm Venereol 2005;85 (5) 451- 452
PubMed
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Figure 1

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).

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Figure 2

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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