Journal article
Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine
Clinical medicine & research, Vol.11(1), pp.26-30
02/2013
DOI: 10.3121/cmr.2012.1085
PMCID: PMC3573092
PMID: 22723468
Abstract
We report a case of cutaneous vasculopathy associated with the use of levamisole-adulterated cocaine. This recently described clinical entity is characterized by a purpuric rash with a predilection for the ears, leukopenia, and anti-neutrophilic cytoplasmic antibody (ANCA) positivity. It is estimated that more than 70% of the current United States cocaine supply is contaminated with levamisole. Levamisole is a widely available, inexpensive, white powder used as a “cutting agent” in cocaine to expand volume and increase profits. It may also increase the euphoric and stimulatory effects of cocaine by increasing brain dopamine levels and producing amphetamine-like metabolites. Our patient exhibited a characteristic rash with involvement of the ears, leukopenia, and cocaine metabolites were detected in serum and urine. The presence of levamisole was confirmed in the urine utilizing gas chromatography-mass spectrometry. ANCA positivity was also present. Punch biopsy of the skin demonstrated vascular thrombosis and necrosis without true vasculitis. We review the literature for reported cases of cocaine-levamisole cutaneous vasculopathy syndrome, highlight the salient immunologic abnormalities, and contrast the features of this entity with idiopathic systemic vasculitis.
Details
- Title: Subtitle
- Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine
- Creators
- Huy Tran - Internal Medicine Residency Program, Department of Medicine, St. Elizabeth Health Center, Youngstown, Ohio, USADebbie Tan - Internal Medicine Residency Program, Department of Medicine, St. Elizabeth Health Center, Youngstown, Ohio, USAThomas P Marnejon - Internal Medicine Residency Program, Department of Medicine, St. Elizabeth Health Center, Youngstown, Ohio, USA
- Resource Type
- Journal article
- Publication Details
- Clinical medicine & research, Vol.11(1), pp.26-30
- Publisher
- Marshfield Clinic
- DOI
- 10.3121/cmr.2012.1085
- PMID
- 22723468
- PMCID
- PMC3573092
- ISSN
- 1539-4182
- eISSN
- 1554-6179
- Language
- English
- Date published
- 02/2013
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984094538402771
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