Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole
| Autor: | John G. Hanly, Peter J. Green, Noreen M. Walsh, Sylvia Pasternak, Rufus W. Burlingame |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Vasculitis Pathology medicine.medical_specialty Histology Biopsy Dermatology Neutropenia Antibodies Antineutrophil Cytoplasmic Pathology and Forensic Medicine Serology Diagnosis Differential Drug Hypersensitivity Cocaine-Related Disorders Cocaine medicine Humans Purpura Anti-neutrophil cytoplasmic antibody medicine.diagnostic_test business.industry Granulomatosis with Polyangiitis Middle Aged Levamisole Antiphospholipid Syndrome medicine.disease Antirheumatic Agents Female medicine.symptom business Systemic vasculitis medicine.drug |
| Zdroj: | Journal of Cutaneous Pathology. 37:1212-1219 |
| ISSN: | 0303-6987 |
| DOI: | 10.1111/j.1600-0560.2010.01613.x |
| Popis: | The term 'cocaine-induced pseudovasculitis' was coined to encompass a constellation of clinical and laboratory findings which mimics a systemic vasculitis but lacks confirmatory evidence of vasculitis on biopsy. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase (HNE) have been reported to distinguish the cocaine-related syndrome from a true autoimmune vasculitis. Published cases of retiform purpura related to cocaine use are rare and an etiologic role for levamisole, a common adulterant of cocaine, has been postulated. We describe two female patients aged 39 and 49 years with cocaine-related retiform purpura, mainly affecting the legs. The initial clinical and serological profile in case 1 led to a suspicion of anti-phospholipid syndrome and in case 2 to Wegener's granulomatosis with an unexplained associated neutropenia. Skin biopsies revealed a mixed pattern of leukocytoclastic vasculitis and microvascular thrombosis in case 1 and pure microvascular thrombosis in case 2. Identification of anti-HNE antibodies in both patients linked their disease to cocaine. The mixed vasculopathic pattern in case 1 and the associated neutropenia in case 2, both known adverse effects of levamisole, point to this as the true etiologic agent. Urine toxicology shortly after a binge of cocaine use in each case was positive for levamisole. |
| Databáze: | OpenAIRE |
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