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Lemon juice and Candida endophthalmitis in crack-cocaine misuse
  1. Thomas A Albini1,
  2. Regina L Sun1,
  3. Eric R Holz1,
  4. Rahul N Khurana2,
  5. Narsing A Rao2
  1. 1Department of Ophthalmology, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas, USA
  2. 2Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of the Southern California, Los Angeles, California, USA
  1. Correspondence to: Dr T Albini Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136, USA; talbini{at}med.miami.edu

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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 …

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