A Case of Xylazine-Induced Necrotic Skin Ulcerations in an IV-Drug User in Florida.

Introduction: As illicit drug manufacturers find new ways to market their products and increase their profit margins, multiple contaminants have found their way into the illicit drug supply. The newest addition, xylazine, also known as "tranq," has spread through the city of Philadelphia and has recently been gaining ground across the United States, including in the state of Florida.

Case presentation: This case describes a 37-year-old male with a significant past psychiatric history of severe polysubstance intravenous (IV) use, including fentanyl and methamphetamine. He was comorbid with other mental and physical conditions and presented to the emergency department with acute psychosis and worsening multi-digit ulcerations. The patient reported that the ulcerations started and progressed since he began injecting fentanyl cut with tranq. The patient was hospitalized for over 30 days due to his complex psychiatric illness as well as complications related to his ulcerations. Over the course of the hospitalization, the ulcerations began to heal, which was likely due to stopping IV drug use and receiving IV antibiotics in a restricted setting.

Conclusion: Continued use of IV drugs that are contaminated with xylazine or other dangerous additives can lead to increased morbidity and mortality. Suspicion of xylazine contamination should be prompt in patients with a history of IV drug use, skin ulcerations, and suspected opiate overdose that is unresponsive to naloxone. Further research on and awareness of the presence of xylazine in illicit drug supplies across the country is crucial to the prevention and early detection of xylazine-related complications.