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Practice

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

Feras M. Ghazawi and Jennifer Beecker
CMAJ June 24, 2019 191 (25) E712; DOI: https://doi.org/10.1503/cmaj.190027
Feras M. Ghazawi
Division of Dermatology (Ghazawi, Beecker), University of Ottawa; Department of Medicine (Beecker), The Ottawa Hospital; Ottawa Hospital Research Institute (Beecker), Ottawa, Ont.
MD PhD
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Jennifer Beecker
Division of Dermatology (Ghazawi, Beecker), University of Ottawa; Department of Medicine (Beecker), The Ottawa Hospital; Ottawa Hospital Research Institute (Beecker), Ottawa, Ont.
MD
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  • RE: First report of krokodil in Canada
    Ian V Mitchell
    Posted on: 11 July 2019
  • Posted on: (11 July 2019)
    Page navigation anchor for RE: First report of krokodil in Canada
    RE: First report of krokodil in Canada
    • Ian V Mitchell, Emergency Physician, Royal Inland Hospital

    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/

    Competing Interests: None declared.
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Canadian Medical Association Journal: 191 (25)
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Vol. 191, Issue 25
24 Jun 2019
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Necrotic leg ulcers associated with krokodil injection in a 41-year-old man
Feras M. Ghazawi, Jennifer Beecker
CMAJ Jun 2019, 191 (25) E712; DOI: 10.1503/cmaj.190027

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Necrotic leg ulcers associated with krokodil injection in a 41-year-old man
Feras M. Ghazawi, Jennifer Beecker
CMAJ Jun 2019, 191 (25) E712; DOI: 10.1503/cmaj.190027
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