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During a recent 5-month period, 16 intravenous heroin users were hospitalized with a previously unrecognized complication of drug abuse. The characteristic symptoms were similar in all patients and included fever, paraspinal myalgias, and periarthritis. There was no evidence of bacterial infection, hepatitis, or drug abstinence as the cause of these musculoskeletal symptoms. Continued heroin use was associated with progressive musculoskeletal symptoms, while discontinuation of heroin use resulted in complete recovery. Antibiotics did not affect the outcome, and the syndrome was self-limited in all hospitalized patients. The pathogenesis of this syndrome is unknown but may be related to the heroin, which was described as brown by the patients, or an adulterant. [ABSTRACT FROM AUTHOR]

Five young male heroin users presented with a syndrome resembling acute immune thrombocytopenic purpura. Although a viral, autoimmune, or toxic origin cannot be conclusively excluded at present, data are most consistent with the hypothesis that the thrombocytopenia was due to a drug-related immunologic mechanism that resulted in peripheral platelet destruction. Epidemiologic considerations suggest the common agent involved in their illnesses was present in the heroin they used. Although glucocorticoid therapy was followed by clinical recovery in four of the five patients (one was lost to follow-up), it is not certain that this represented a causal relation.