Local complications secondary to intravascular cocaine injection are various, with cellulitis, abscess and tissue necrosis. Cervical involvement after direct injection incurs a risk of major hemorrhage, due to the proximity of vascular structures.

A female patient presented necrosing cervical fasciitis secondary to cocaine injection in the external jugular vein. She consulted 3 weeks later with a large ulcer at the base of the sternocleidomastoid muscle. Biological and radiological assessment confirmed the absence of any deep vascular complications but revealed necrosis associated with deep cervical abscesses. She underwent emergency surgery to resect the necrotic tissue, drain the collections and ligate the vein. Viable muscle above the vascular fascia made flap coverage unnecessary. Directed healing provided favorable progression. Postoperative course was straightforward, and addictologic follow-up was initiated.

Intravascular cocaine injection can lead to deep cervical necrosis, which could be serious due to the vascular risk. Urgent specialized treatment is essential to prevent complications.