Foot Ulceration Following Unintentional Xylazine Injection
A case report by Eric Kaplan, DPM, and Jacob Kaplan highlights a foot ulcer resulting from inadvertent xylazine exposure during illicit drug use. Xylazine, an alpha-2 agonist increasingly found in unregulated opioid supplies, causes local vasoconstriction leading to tissue necrosis and ulceration. :contentReference[oaicite:turn0search0]{index=0}
Key Highlights:
- Initial Presentation: A patient developed redness, warmth, and edema near injection sites, progressing to a heterogeneous lesion measuring approximately 3.3 cm² on ultrasound, along with tenosynovitis on MRI. Intravenous antibiotics (vancomycin, piperacillin/tazobactam, then cefazolin) were administered. :contentReference[oaicite:turn0search0]{index=0}
- Ulcer Formation: Five days post-discharge, the patient returned with a foul‑smelling, necrotic, draining ulcer (~3 cm²) reaching to the mid-calf, necessitating hospital readmission and broad‑spectrum IV antibiotics. :contentReference[oaicite:turn0search0]{index=0}
- Xylazine Detection: Drug testing revealed that the patient’s supply of heroin/cocaine contained xylazine (“Tranq”), confirming the cause of the ulcer based on vasoconstrictive skin effects. :contentReference[oaicite:turn0search0]{index=0}
- Treatment Course: Management included sharp debridement down to the tibialis anterior tendon, xeroform dressing, and a transition to oral antibiotics (amoxicillin/clavulanate plus trimethoprim-sulfamethoxazole) post‑hospitalization. :contentReference[oaicite:turn0search0]{index=0}
- Clinical Conclusion: Xylazine-induced necrosis presents unique challenges due to unknown drug interactions and requires aggressive antimicrobial therapy paired with surgical debridement. The authors call for further research to understand underlying mechanisms and refine treatment protocols. :contentReference[oaicite:turn0search0]{index=0}
This case underscores the emerging threat of xylazine in unregulated drug supplies and emphasizes the need for awareness among clinicians managing foot ulcerations in this population.
Read the full case report on the HMP Global Learning Network (Podiatry Today).
Keywords:
xylazine ulceration,
alpha‑2 agonist,
drug injection ulcer,
sharp debridement,
necrotic ulceration