A 32-year-old man using IV fentanyl develops necrotic chest wounds and osteomyelitis. Discover the dangerous adulterant causing these severe skin injuries.
A 32-year-old man presented with 1-month history of enlarging necrotic chest wounds. He reported a 3-year history of daily use of fentanyl by injection into his neck and arm veins. CT of the chest showed osteomyelitis of the clavicles and manubrium, in addition to soft-tissue ulceration and inflammation. Adulteration of fentanyl by which of the following substances is most likely to have contributed to the development of these superinfected wounds?
What is the most likely diagnosis?
Fentanyl, Opioid-Use Disorder, Osteomyelitis, Skin Necrosis, Xylazine
