The Centers for Disease Control and Prevention recently reported that a substantial number of drug misusers in the US are injecting crack-cocaine instead of smoking it,¹ owing to the decreased availability and increased cost of powdered cocaine. The use of lemon juice to dissolve crack-cocaine has been shown to cause abscesses, permanent vein damage and infections.² Furthermore, heroin dissolved in preserved lemon juice was documented to be a source of Candidaalbicans in multiple, small epidemics of fungal endophthalmitis in the 1980s in the UK and Australia.^3,4 We report here two recent cases of fungal endophthalmitis in crack users who similarly disclose dissolving crack-cocaine in lemon juice injection.

Case 1

A 34-year-old male intravenous drug user presented to his primary care physician with high fever …