Equal author contribution.
Successful Medical Treatment of Glans Ischemia after Voluntary Buprenorphine Injection
Article first published online: 12 AUG 2013
© 2013 International Society for Sexual Medicine
The Journal of Sexual Medicine
Volume 10, Issue 11, pages 2866–2870, November 2013
How to Cite
Brecheteau, F., Grison, P., Abraham, P., Lebdai, S., Kemgang, S., Souday, V., Nedelcu, C., Culty, T., Larré, S., Azzouzi, A. R. and Bigot, P. (2013), Successful Medical Treatment of Glans Ischemia after Voluntary Buprenorphine Injection. Journal of Sexual Medicine, 10: 2866–2870. doi: 10.1111/jsm.12282
- Issue published online: 4 NOV 2013
- Article first published online: 12 AUG 2013
- Intravenous Injection;
- Laser Speckle Contrast Imaging;
- Hyperbaric Oxygen Therapy
The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection.
We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below.
A 26-year-old male drug addict presented with glans pain 4 days after self-injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis.
After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28-day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications.
To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy. Brecheteau F, Grison P, Abraham P, Lebdai S, Kemgang S, Souday V, Nedelcu C, Culty T, Larré S, Azzouzi AR, and Bigot P. Successful medical treatment of glans ischemia after voluntary buprenorphine injection. J Sex Med 2013;10:2866–2870.