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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Community+Hosp+Intern+Med+Perspect
2017 ; 7
(5
): 321-324
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Vanishing vasculitis: a case of acute necrotic skin findings without pathologic
features of vasculitis from adulterated cocaine
#MMPMID29147477
Ghias AAP
; Brine P
J Community Hosp Intern Med Perspect
2017[]; 7
(5
): 321-324
PMID29147477
show ga
While the usage of illicit drugs in itself carries significant health risks and
associated toxicities, drugs that are adulterated to give them volume, alter
their psychogenic properties, and make them cheaper to produce are to be
considered even more dangerous. Cocaine is one of them, and it is now most
commonly being adulterated with levamisole. We report a case of a 37-year-old
female with the chief complaint of painful skin lesions and wounds on both of her
upper and lower extremities for three weeks duration. She was tested positive for
cocaine and had classical purpuric, ecchymotic, and necrotic patches on both
ears, which are pathognomonic. She also had multiple wounds in extremities. The
cocaine-levamisole related syndrome comprises a set of immunological
abnormalities, out of which, ANCA positivity is the most important one. Our
patient was ANCA positive. Regarding pathological findings in cocaine adulterated
with levamisole syndrome, this can range from the classic finding of
leukocytoclastic vasculitis of small vessels to occlusive vascular disease
without true vasculitis. Our case's biopsy showed no vasculitis, and this is why
it is important to highlight that cocaine can also cause a pseudo-vasculitic
picture. The other possibility that we entertained was that of pyoderma
gangrenosum as the skin finding in levamisole-contaminated cocaine, and the
lesion was consistent in appearance. Recently, there have been a few case reports
of pyoderma gangrenosum from adulterated cocaine with levamisole, where skin
findings were consistent with pyoderma gangrenosum; however, serological findings
rather favored levamisole vasculopathy or vasculitis. Therefore, we should
familiarize ourselves with the multitude of pathological and skin findings that
adulterated cocaine can cause and, finally, make ourselves aware that the
classical pathological finding of vasculitis in such cases is not always seen.