Intranasal acetaminophen induced nasal tissue necrosis and septal perforation: A case report and literature review

Intranasal abuse of drugs such as cocaine, heroin, and combination opioid/non-opioid medication are well documented in the literature, but intranasal abuse of acetaminophen is rarely described. Here we present a case report of an otherwise healthy 39-year-old female who presented with significant sinus pain, nasal congestion, anosmia, rhinorrhea, throat discomfort and odynophagia five months after starting intranasal abuse of 10 tablets of acetaminophen daily. Anterior rhinoscopy revealed a large and inflamed anterior septal perforation with exposed cartilage. Significant debris and acetaminophen tablet residue was present is both nasal cavities. With Suboxone (buprenorphine/naloxone) therapy, she succeeded in cessation of drug use. Due to her ongoing complaints of nasal obstruction, not resolving with medical management, surgery was arranged. This is the first reported case of intranasal acetaminophen abuse in Canada and the first documented case where suboxone was used to help taper intranasal acetaminophen use prior to surgical intervention.