Clinical, histopathologic, and immunofluorescence findings in levamisole/cocaine‐induced thrombotic vasculitis

Crowe, David R.; Kim, Pamina S.; Mutasim, Diya F.

doi:10.1111/j.1365-4632.2012.05667.x

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…A series of 14 patients with a history of IVDU with multisystemic necrotizing angiitis and a case of necrotizing angiitis occurring after methamphetamine use have been reported in the literature . LCV may also be seen in levamisole‐induced thrombotic vasculitis in users of levamisole‐contaminated cocaine . Vessel wall necrosis with intravascular thrombosis has been reported in response to subcutaneous injections of cocaine in rats, a response which may be caused by the direct vascular cytotoxic effects of cocaine .…”

Section: Discussionmentioning

confidence: 99%

“…13,14 LCV may also be seen in levamisole-induced thrombotic vasculitis in users of levamisole-contaminated cocaine. 16,17 Vessel wall necrosis with intravascular thrombosis has been reported in response to subcutaneous injections of cocaine in rats, a response which may be caused by the direct vascular cytotoxic effects of cocaine. 18 Intravascular thrombosis was not identified in our cases.…”

Section: Leukocytoclastic Vasculitismentioning

confidence: 99%

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Dermatopathologic manifestations of intravenous drug use

et al. 2015

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Cutaneous manifestations of IVDU should be considered in the differential as an etiology for dermatopathologic findings in high-risk patients. We report histopathological findings beyond the scope of those most commonly associated with IVDU. We aim to raise awareness of the cutaneous manifestations of IVDU to improve clinicopathological correlation and patient management in light of the ongoing epidemic.

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Section: Discussionmentioning

confidence: 99%

Section: Leukocytoclastic Vasculitismentioning

confidence: 99%

Dermatopathologic manifestations of intravenous drug use

et al. 2015

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“…Limited forms of facial ulceration with nasal cartilage destruction have been linked to chronic cocaine abuse. Levamisole‐tainted cocaine can also create purpuric lesions and generate a mixed pattern of ANCA, including PR3‐ANCA and MPO‐ANCA 20,21 . Recent reports discuss pyoderma gangrenosum lesions on the extremities or truncal area in this setting in the absence of clinically apparent purpura 22 .…”

Section: Granulomatosis With Polyangiitis (Gpa)mentioning

confidence: 99%

“…Levamisole-tainted cocaine can also create purpuric lesions and generate a mixed pattern of ANCA, including PR3-ANCA and MPO-ANCA. 20,21 Recent reports discuss pyoderma gangrenosum lesions on the extremities or truncal area in this setting in the absence of clinically apparent purpura. 22 Diagnosis can be quite challenging.…”

Section: Granulomatosis With Polyangiitis (Gpa)mentioning

confidence: 99%

Cutaneous manifestations of antineutrophil cytoplasmic antibody‐associated vasculitis (AAV): a concise review with emphasis on clinical and histopathologic correlation

Gibson

2022

Int J Dermatology

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a group of small vessel vasculitides grouped by commonalities of clinical manifestations and ANCA testing. Skin findings are not uncommon, although there is considerable overlap and many times nonspecificity. In general, patients with skin findings tend to have more significant systemic illness, and skin lesions most often develop simultaneously or following onset of systemic symptoms. There are clinical and pathological clues of help in the differentiation of skin findings in these disorders. Purpura of various forms with leukocytoclastic vasculitis is common to all AAV. Granulomatosis with polyangiitis (GPA) comprises the largest number of patients with an AAV. Upper airway, oral, ear, and facial lesions, with or without granuloma, are more commonly seen in this AAV. Pyoderma gangrenosum-like lesions, including facial location, while not common are most closely associated with GPA.Eosinophilic granulomatosis with polyangiitis (EGPA) as its name implies is more closely associated with eosinophilic, allergic, or asthmatic conditions. Papular lesions of the extensor extremities showing extravascular granulomatous changes are characteristic but not specific for EGPA. Microscopic polyangiitis (MPA) is more closely associated with livedoid skin changes, and vascular inflammation tends to be deeper in the skin than with the other AAV. Extravascular granulomas are not expected. While the skin findings in AAV can be nonspecific and overlapping, combining careful full skin examination with histopathologic study of selected lesions is critical to making the correct diagnosis and in ruling out other similar diseases not ANCA related. The aim of this article is to encourage increased participation by dermatologists and dermatopathologists in the care of these patients.

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“…It is logically not about its halflife approximately around 5.5 h with renal excretion that allows finding it at least 1 or 2 days after intoxication both in blood or urine (3,(8)(9)(10). According to previous studies (7,(11)(12)(13)(14), toxicology investigations regarding levamisole intoxication require knowledge and clinical suspicion although its detection is possible with mass spectrometry and gas chromatography in routine and levamisole is listed in the Maurer/Pfleger/Weber toxicology library.…”

Section: Levamisole Use and Detectionmentioning

confidence: 99%

Extensive Necrotic Purpura in Levamisole‐Adulterated Cocaine Abuse – A Case Report

Garff

Tournel

Becquart

et al. 2016

Journal of Forensic Sciences

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Levamisole, which is used as an adulterated compound of cocaine, is currently being seen year after year in cocaine intoxication. For a few cases in the last decade, necrotic purpura and neutropenia after levamisole/cocaine intoxication have been described in the medical community. Herein, we present an original case of levamisole intoxication of a 40-year-old woman who smoked heroin and cocaine few during a month. She rapidly presented an extensive necrotic purpura of the nose, cheeks and extremities (lower and upper), and immunologic reactions (positive anti-MPO and anti-HNE). Levamisole was detected on hairs with ultra-high performance liquid chromatography and tandem mass spectrometry. The case reports also a probable cocaine supplier deceit, which bring pure drug for hospital investigation after the intoxication of his client. The intoxicated woman had survived with several skin and chronic pain complications. That case recalls the knowledge about levamisole with a short review of the forensic literature.

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Clinical, histopathologic, and immunofluorescence findings in levamisole/cocaine‐induced thrombotic vasculitis

Cited by 9 publications

References 18 publications

Dermatopathologic manifestations of intravenous drug use

Dermatopathologic manifestations of intravenous drug use

Cutaneous manifestations of antineutrophil cytoplasmic antibody‐associated vasculitis (AAV): a concise review with emphasis on clinical and histopathologic correlation

Extensive Necrotic Purpura in Levamisole‐Adulterated Cocaine Abuse – A Case Report

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