Case Report
 
New case of krokodil (desomorphine) use
Savalan Babapoor-Farrokhran1,2, Mario D. Caldararo1, Sara Naji Rad2, Frederick N. Laborde2, Rameez Rehman2, Jose Mejia2
1Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
2Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, USA

Article ID: 100901Z01SB2018
doi: 10.5348/100901Z01SB2018CR

Corresponding Author:
Savalan Babapoor-Farrokhran, MD,
Department of Internal Medicine, Thomas Jefferson University Hospital,
Philadelphia, PA 19107, United States

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How to cite this article
Babapoor-Farrokhran S, Caldararo MD, Rad SN, Laborde FN, Rehman R, Mejia J. New case of krokodil (desomorphine) use. Int J Case Rep Images 2018;9:100901Z01SB2018.


ABSTRACT

Introduction: Krokodil use was first reported in Siberia in 2002. The drug derives its name from the harms associated with its use, such as ulcerations and discolored necrotic scaled skin which may resemble crocodile skin. It has also been described as “flesh eating”, as it finally disrupts the skin leaving the bone and muscle exposed to infections.

Case Report: A 27-year-old female with past medical history of intravenous opioid dependence for 5–6 years and gastroesophageal reflux disease who presented with ulcerations of the posterior aspects of her arms bilaterally. The patient reported injecting krokodil for the past 5–6 months. She had been observing blue and black discoloration of the skin 1–2 days after each injection for the past 4–5 months. The injection site scabbed after 2–3 days. The patient continued injecting in area next to the affected sites. Eventually the affected sites coalesced and evolved into a large scab containing black necrotic tissue. In the last 5–6 days the black necrotic tissue started peeling off made the underlying tissue visible with mild greenish purulent discharge. She was treated with intravenous antibiotics and intensive wound care and was observed for opiate withdrawal. She was referred to plastic surgery for wound care and skin grafting.

Conclusion: Krokodil is highly addictive and reports of its use began cropping up in the U.S. This case is the first case reported in New York.

Keywords: Desomorphine, Heroin, Krokodil, Necrotic wound


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Author Contributions
Savalan Babapoor-Farrokhran – Substantial contributions to conception and design, Acquisition of data, interpretation and analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mario D. Caldararo – Substantial contributions to conception and design, Revising the article critically for important intellectual content, Final approval of the version to be published
Sara Naji Rad – Substantial contributions to conception and design, Revising the article critically for important intellectual content, Final approval of the version to be published
Frederick N. Laborde – Substantial contributions to conception and design, Revising the article critically for important intellectual content, Final approval of the version to be published
Rameez Rehman – Substantial contributions to conception and design, Revising the article critically for important intellectual content, Final approval of the version to be published
Jose Mejia – Substantial contributions to conception and design, Revising the article critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Savalan Babapoor-Farrokhran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.