Objective: To study the clinical and neuroimaging features of a patient with a long-term use (more than 10 years) of desomorphine in the anamnesis.

Background: Drug addiction caused by the use of artisanal deomorphine, which has the informal name “crocodile” in Russia, became widespread after 2000 and began to spread especially rapidly after 2005 [1]. Apart of acute and chronic pathological conditions involving various organs’ lesion, it can cause severe motor disorders in the form of dystonia, parkinsonism, postural disorders, as well as cognitive and affective deficit [2].”Crocodile” is an extremely toxic mixture due to its components: the active substance deomorphine, intermediate products of catalytic reduction and ballast substances, as well as their compounds: non-reacted phosphorus, iodine and solvent components (heavy metals). The chemical composition of a narcotic drug may differ depending on the technology of the production stage, the availability and quality of the raw materials and its components, as well as the preferences of those who use it [2,3,4].

Method: We present a clinical case of a patient N., 49, who has been using drugs since 2000. Since 2001 she has been taking heroin for a long time, then since 2003, she switched to “crocodile”. She have been using it until 2013, with the periodical change onto heroin and back. In 2007 the diagnoses of HIV infection and hepatitis B were officially established. In 2018 N. has undergone antiviral treatment at the HIV center. Since 2021 N. has not used drugs. Her parents strictly monitor her behavior and they live together. However in 2022 pronounced unsteady gait while walking, choreiform hyperkinesis in the face, limbs, trunk, as well as general slowness, stiffness appeared. The patients was referred to Republican Center for Movement Disorders (Kazan).

Results: The patient underwent a course of intravenous amantadine sulfate 400 mg for 8 days with complete regression of symptoms. The patient found job and washed dishes. However in October 2023 choreic hyperkinesis reappeared and she quit because, due to the severity of hyperkinesis, she could not walk at work on her own and do her job. Against the background of a repeated intravenous course of amantadine sulfate, choreic hyperkinesis persisted. On MRI, the patient has accumulation of heavy metals in white matter (Fig.1)

Conclusion: Movement disorders may appear delayed after prolonged use of desomorphine.

Heavy metal accumulation in white matter On MRI

Heavy metal accumulation in white matter On MRI

Heavy metal accumulation in white matter On MRI

References: 1. [www.apn-spb.ru/publications/article7250.htm Crocodile attack Russia].
2. Nartov S.E., Parkhomenko E.V., Yekusheva E.V., Karpov D.Y. Toxic deomorphine encephalopathy in the use of “crocodile”: clinical and neuroimaging features // Clinicheskaya practika – 2022. – Т. 13. – №1. – C. 30-41. doi: 10.17816/clinpract96475
3. Grund JC, Latypov A, Harris M. Breaking worse: the emergence of Krokodil and excessive injuries among people who inject drugs in Eurasia. Int J Drug Policy. 2013;24(4):265–74. doi: 10.1016/j.drugpo.2013.04.007
4. Alves EA, Soares JX, Afonso CM, et al. The harmful chemistry behind “krokodil”: street-like synthesis and product analysis. Forensic Sci Int. 2015;257:76–82. doi: 10.1016/j.forsciint.2015.07.042

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/delayed-movement-disorders-after-usage-of-desomorphine-crocodile-clinical-case/