Necrotizing Angiitis Associated with Drug Abuse

Fourteen young drug abusers with a necrotizing angiitis indistinguishable from periarteritis nodosa were studied. The six women and eight men had used narcotics, stimulants, hallucinogens and depressants. Methamphetamine, alone or in combination with heroin or d-lysergic acid diethylamide, was used commonly. The clinical presentation varied from a complete lack of symptoms in five patients to pleomorphic systemic signs and symptoms with renal failure, hypertension, pulmonary edema and pancreatitis. The vascular changes of necrotizing angiitis, including arterial aneurysms and sacculations, were noted in the kidney, liver, pancreas and small bowel at selective angiography. Post-mortem findings in four patients revealed generalized vascular changes of differing age, including chronic and healed lesions. Because of the multiplicity of injected substances with the high probability of contamination the exact etiologic agent in these cases is not clear; however, methamphetamine appears to be a common denominator.