Disseminated Candidiasis in Intravenous Drug Abusers: A Distinctive Syndrome

Disseminated candidiasis in intravenous (IV) drug abusers is a distinctive syndrome. The hallmarks of this syndrome include the sequential development of skin, eye, and osteoarticular lesions; an epidemic nature in some cases; association with the use of brown heroin diluted with lemon juice; and the etiologic agent, which almost always is Candida albicans. In this case, a 42-year-old male IV drug user presented with chorioretinitis, subcutaneous scalp nodules, and costochondral lytic lesions from which C albicans was isolated. He had a history of using brown heroin and crack cocaine. Because of their poor solubility, lemon juice had been used to dissolve the drugs before the patient injected them. He was treated with fluconazole and after a course of 4 months his ocular lesions resolved. Physicians should consider and ask about the use of lemon juice in patients who are IV drug users—especially in those presenting with skin, ophthalmologic, and osteoarticular manifestations. Figure 1. Osteoarticular Lesions in an Intravenous Drug User With Disseminated Candidiasis