Xylazine-Associated Skin Injury

A 32-year-old man presented with necrotic chest wounds following daily injection of fentanyl adulterated with xylazine over three years. Imaging revealed osteomyelitis of the clavicles and manubrium. Cultures grew Pseudomonas aeruginosa and Enterococcus species. Treatment involved chest-wall debridement, microsurgical flap reconstruction, 6 weeks of intravenous antimicrobial therapy, and buprenorphine initiation for opioid-use disorder. Xylazine, approved only for veterinary use, is increasingly present in illicit fentanyl and is linked to severe skin injuries, especially on the legs, sometimes unrelated to injection sites. A 6-month follow-up showed successful wound healing and addiction program participation.

A 32-year-old man presented with necrotic chest wounds following daily injection of fentanyl adulterated with xylazine over three years. Imaging revealed osteomyelitis of the clavicles and manubrium. Cultures grew Pseudomonas aeruginosa and Enterococcus species. Treatment involved chest-wall debridement, microsurgical flap reconstruction, 6 weeks of intravenous antimicrobial therapy, and buprenorphine initiation for opioid-use disorder. Xylazine, approved only for veterinary use, is increasingly present in illicit fentanyl and is linked to severe skin injuries, especially on the legs, sometimes unrelated to injection sites. A 6-month follow-up showed successful wound healing and addiction program participation.