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Consultations & comments.

Article Excerpt
What's Biting Methamphetamine Users?

I found Joe Monroe's Photoclinic case of a patient with dermatitis artefacta very interesting (CONSULTANT, December 2000, page 2406). The patient might have been exhibiting a phenomenon sometimes seen in methamphetamine users that is referred to as "crank bug bites." Patients claim to see and/or feel bugs on their body and attempt to remove them or pick at them until they create open wounds and scabs (Figure).

I recently saw a patient with multiple lesions who had come to the emergency department to seek treatment for what he believed were brown recluse spider bites. He said he lived in a basement apartment and had seen several of the spiders that bit him.

However, his lesions did not look like typical brown recluse spider bites. The patient admitted that he had been using methamphetamine. Laboratory findings demonstrated infection with hepatitis B and C viruses.

Thanks to Mr Monroe, I can now give this patient a diagnosis of "dermatitis artefacta."

--Nancy Tosone, MSN, APRN

Omaha

Thank you for relating your experience with dermatitis artefacta. I agree that this phenomenon is often associated with methamphetamine use.

--Joe Monroe, PA-C

Tulsa, Okla

What Cause of Puzzling Hormonally Related Symptoms?

I suspect that my patient has hereditary angioedema (HAE). During her last pregnancy 2 years earlier, she had severe preeclampsia. After delivery, she had persistent, severe migraine-like headaches that were accompanied by facial and lip swelling. Her symptoms seemed to improve after she started taking cetirizine.

However, now that her menses have returned (she was amenorrheic while breast-feeding), she has severe headaches and swelling of the lips; hands, and feet, both at mid cycle and during her periods. Occasionally, she has upper airway stridor and irritable bowel syndrome (IBS)-like symptoms. She has a positive antinuclear antibody titer of 1:160, speckled. All complement levels and erythrocyte sedimentation rate are normal.

Could HAE be responsible for my patient's symptoms?

MD

Recurrent angioedema is...