Cocaine-Induced Four-Extremity Ischemia Caused by a Hypercoagulable State

The use of cocaine is associated with serious complications including coronary vasospasm and myocardial, renal, intestinal, and neurological ischemia. Among these feared complications lies limb ischemia which is a rare potential side effect of chronic cocaine use. We present the case of a 50-year-old female with an extensive history of cocaine use who developed ischemia in all four limbs. Imaging studies revealed pulmonary emboli, multisystem thromboses, and microhemorrhages in the brain. Laboratory studies were significant for leukocytosis, thrombocytopenia, schistocytes on blood smear, and normal rheumatologic and hematologic studies. The patient was diagnosed with cocaine-induced thrombotic microangiopathy and she was treated symptomatically and with continuous heparin infusion. However, she ultimately requested to be discharged home and was lost to follow-up. Cocaine-induced thrombotic microangiopathy has been reported in only a few other patients to date and although there are some theories describing the possible pathophysiology, a clearly defined explanation has not yet been widely accepted.