Puffy Hand Syndrome, IV Drug Use, Chronic Vein Disease, A Case Report, History & Specifics

Intravenous (IV) drug users are at risk for severe vein damage, making the administration of life-saving drugs a challenge. According to the National Highway Traffic Safety Administration, Emergency Medical Services (EMS) cover a scope of treatment that allows first responders to administer medication through an intravenous line. 

Part of the requirement for an EMS is that they are capable of establishing and maintaining access to medication through a patient’s veins. A variety of emergency medical conditions may require first responders to administer drugs through IVs. These include things like hypoglycemia treatment. 

Prolonged and frequent intravenous (IV) drug use may cause permanent damage to the veins at drug injection sites. People requiring regular medical care and people with substance abuse issues may be at risk for these conditions.

Vein damage from IV drug use can lead to chronic venous disorders (CVD). The places on the body people most commonly inject illicit drugs are the arms, hands, and feet. Research has shown that people who inject in their legs are over nine times more likely to develop ulcers in their veins.

Multiple factors influence the level of damage from injecting drugs. One is the kind of drug being injected. Studies on heroin injection illustrate the drug’s acidity has a damaging effect on vein health. The same studies indicate that people who regularly use drugs and suffer from vein damage will seek alternate veins, spreading the damage to other parts of the body. In desperation, drug users may even inject into soft tissue.

IV drug use vein damage is a serious challenge to the administration of life-saving drugs in the event of a medical emergency. The Journal of the American Medical Association has outlined the same method since the 1950s for starting intravenous drugs in a collapsed vein. The emergency solutions include cutting into a vein or finding it difficult to reach veins. Either way, there are very limited options if there is severe vein damage, and these solutions may be too little too late. 

• Chronic vein disease
• Impaired walking mobility
• Hepatitis C

• Skin abscesses or infections
• Thrombosis and blood clots
• Musculoskeletal infections

• Collapsed Veins: When someone suffers a collapsed vein, blood cannot pass as it should through the body. Collapsed vein syndrome can be very painful and lead to deep vein thrombosis.
• Blown Veins: A blown vein occurs when a vein becomes punctured, leaking blood into the tissue around it. A blown-out vein from IV can result in significant bruising. A blown-out vein can also create lumps and swelling.

• Dilated Veins: Dilated veins are sometimes called varicose veins and result from the vessel walls weakening. A web of thin red, blue or purple lines may be a sign that veins have dilated.
• Puffy Hand Syndrome and Swelling of Extremities: Swollen feet from IV drug use is an unpleasant side effect that may indicate greater health issues. Puffy Hand Syndrome after IV drug use can limit a person’s movement and functionality in daily life. 

Puffy hand syndrome develops in long-term intravenous drug users. The frequency and severity of the complications of this syndrome are rarely reported. Here was reported a case of puffy hand syndrome revealed by a severe staphylococcal infection with toxic complications mimicking a four limbs cellulitis.

A 41-year-old man was admitted to the institution for bilateral feet, legs, arms, and hand edema with fever. He had a previous history of HCV hepatitis and intravenous heroin addiction cured fifteen years ago. Heroin addiction was substituted by buprenorphine, without buprenorphine intravenous injection.

He had been reporting progressive feet and hands edema for several years, which became permanent for six months. He saw his general practitioner for worsening edema with the erythema. He has been prescribed paracetamol and a nonsteroidal anti-inflammatory drug. Five days later, he went to the emergency department for abdominal pain and bullous lesions of legs and arms. He had a 39°C fever and severe sepsis clinical criteria.

He had nonpitting edema with erythema of feet, legs, hands, and forearms. Several bullous lesions affected his hands and feet without a formal argument for necrotizing fasciitis or a staphylococcal scalded skin syndrome.

Puffy hand syndrome is a long-term complication of intravenous drug abuse. Firstly described by Abeles in 1965 in New York prisoners, it could affect from 7 to 16% intravenous drug users. Injections in the hands and in the feet, and the absence of a tourniquet are significant risk factors for puffy hand syndrome. It starts during or after a long period of intravenous drug addiction with intermittent painless edema.

After several months of evolution, the edema becomes permanent and does not decrease with the elevation of the upper limb. It is a nonpitting or slightly pitting, affecting the dorsal side of fingers and hands with puffy aspect, sometimes asymmetric (more important in the nondominant member), with skin thickness. Feet involvement is less frequent, related to the lower limbs injections

Acrocyanosis and Raynaud phenomenon have been reported. Local infectious complications such as cellulitis can be severe and frequently enable the diagnosis. Indeed, the patients suffering from puffy hand syndrome rarely consult for the edema due to the guilt feelings and despite the functional, aesthetic, and social disagreements.