SHM Converge Scientific Abstract ePoster Gallery-Skin Necrosis: A Not So 'Tranq' Uil Experience

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This case highlights xylazine, a veterinary sedative increasingly found as an adulterant in illicit drugs, especially fentanyl. Xylazine is a potent alpha-2 adrenergic agonist that causes sedation, muscle relaxation, and reduced pain perception, but in humans it can also cause bradycardia, hypotension, respiratory depression, and CNS depression. Because it is not an opioid, naloxone does not reverse its effects.<br /><br />A major emerging complication is xylazine-associated skin injury, believed to result from chronic peripheral vasoconstriction. These lesions often appear as ulcerations or areas of skin necrosis and can progress to serious secondary infections such as cellulitis, myositis, osteomyelitis, or necrotizing fasciitis.<br /><br />The patient was a 42-year-old man with IV drug use who presented with four weeks of bilateral forearm lesions and one week of right-hand swelling and anesthesia. He was afebrile but tachycardic, with elevated CRP and otherwise unremarkable labs. His hospital course included empiric IV antibiotics, extensive surgical debridement, discontinuation of antibiotics after a second debridement, and initiation of methadone for opioid use disorder.<br /><br />Key management steps for suspected xylazine-related skin injury include obtaining blood and wound cultures, considering imaging such as x-ray or MRI to evaluate for deeper infection, providing wound care and debridement, treating secondary infections, and considering amputation in severe cases.<br /><br />The main clinical takeaway is to maintain a high index of suspicion for xylazine exposure in patients who inject illicit drugs, since this emerging contaminant is making already dangerous drugs even more harmful.

Asset Subtitle

Amy Tierney

Meta Tag

Author List Amy Tierney, Elizabeth Cole, Evan Raff, Mukhtar Adem

Category Clinical Vignettes

Concept Xylazine

Concept Skin Necrosis

Concept Fentanyl

Concept Skin ulcer

Concept Respiratory Depression

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Amy Tierney

Track Adult

Keywords

xylazine

fentanyl adulterant

skin necrosis

ulcerations

intravenous drug use

wound debridement

secondary infection

naloxone ineffective

alpha-2 adrenergic agonist

opioid use disorder

Xylazine

Skin Necrosis

Fentanyl

Skin ulcer

Respiratory Depression