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Heroin Addiction. Presented by C. Heaton, MD; R. Bennett, MD; and J. Decherd, MD.
The patient's history revealed rheumatic fever at age 7, eclampsia, partial hysterectomy cholelithiasis, adult onset diabetes, and hepatitis. The patient has been a heroin addict since 1968 and admitted to "skin popping" recently as her veins have "run out." Multiple ulcers over both arms and a few ulcers on her legs are in several stages of healing.Results of laboratory studies showed electrolytes, blood urea nitrogen, and glucose levels within normal limits; the rapid plasma reagent card test was nonreactive; the hemoglobin level was 11.2 gm/100 ml; the white blood cell count was 6.6/cu mm, with 3% band cells, 68% segments, 23% lymphocytes, 4% monocytes, and 2% eosinophils. The automated multiple analysis system was within normal limits except for total proteins of 9.9. Culture of abscesses yielded a coagulase-positive staphylococcus and a β-streptococcus group A. Urinalysis