Necrotic leg ulcers associated with krokodil injection in a 41-year-old man

Dear CMAJ:

While these images are certainly graphic, their origin is as murky as the existence of Bigfoot, confirmed only by second hand oral reports. Although the authors report that use of krokodil (desomorphine) has been increasing in North America, there have been no toxicologically confirmed reports of krokodil in North America, ever. (1) Past claims of krokodil have been circulating since 2013, all equally unencumbered by any toxicological evidence. Nor have these authors been able to explain how their patient was able to access large quantities of codeine as a precursor and why the patient would favor this toxic homemade brew over more easily accessible heroin.
While a diagnosis of pyoderma granulosum with secondary infection is less glamourous and less worthy of publication, it has the advantage of being more plausible than the first recorded instance of krokodil in Canada.
1. PubMed Central Link [Internet]. [cited 2019 Jul 11]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107723/