Crushed it: Elucidation of systemic vasculitis caused by injected hydromorphone tablets via skin biopsy

The increase of the opioid crisis has brought about increased regulations and decreased prescriptions for opioids in the United States.10 There is a national shortage of intravenous hydromorphone that may cause already addicted patients to seek other means of narcotic administration, including injection of crushed hydromorphone tablets intravenously. In patients who present with necrotizing vasculitis and unusual serologies, a thorough drug use history is warranted, and skin biopsy with polarized light microscopy may elucidate pathomechanisms of a multisystem process.