Intra-arterial self-injection of methadone tablets into the femoral artery

Background: Accidental intra-arterial (IA) injection of a drug of abuse is a rare but potentially limb-threatening occurrence that causes rhabdomyolysis and limb ischemia through a number of mechanisms. Methadone tablets contain microcrystalline cellulose, which has been shown to cause gangrene in animal studies.

Objectives: We present a case of IA injection of methadone tablets dissolved in water, followed by a brief review of the literature.

Case report: A former heroin abuser presented to the Emergency Department after injecting 10 10-mg methadone tablets dissolved in water into his femoral artery. He had severe pain and cyanosis of his leg. Laboratory data revealed a creatine kinase (CK) of 4208. He was started on heparin, low molecular-weight dextran, decadron, sodium bicarbonate, and intravenous dilaudid. An angiogram showed distal small particle embolization and focal areas of spasm. He was discharged on hospital day 6 with patchy mottling throughout the lower extremity and a CK of 30,000. He was treated with nifedipine, enoxaparin, and Coumadin, as well as pain medications.

Conclusion: We report a case of IA injection of methadone into the femoral artery causing limb ischemia and rhabdomyolysis. This patient responded to medical therapy.