Cocaine abuse and connective tissue disease

Trozak, Daniel J.

doi:10.1016/s0190-9622(84)80112-7

Cited by 35 publications

(8 citation statements)

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“…There are several reports in the literature of patients with midline destructive lesions, a vasculopathic skin eruption and cANCA‐positive serology who were initially thought to have WG but later shown to have cocaine‐related disease. Other rheumatic diseases in this category are Churg–Strauss granulomatosis, pANCA‐positive necrotizing vasculitis, limited scleroderma and APS 7,12–17 . Conventional autoimmune serological studies cannot discriminate between the cocaine‐related syndromes and primary autoimmune disorders.…”

Section: Discussionmentioning

confidence: 99%

Cocaine‐related retiform purpura: evidence to incriminate the adulterant, levamisole

Walsh¹,

Green²,

Burlingame³

et al. 2010

J Cutan Pathol

102

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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. Walsh NMG, Green PJ, Burlingame RW, Pasternak S, Hanly JG. Cocaine‐related retiform purpura: evidence to incriminate the adulterant, levamisole.

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Section: Discussionmentioning

confidence: 99%

Cocaine‐related retiform purpura: evidence to incriminate the adulterant, levamisole

Walsh¹,

Green²,

Burlingame³

et al. 2010

J Cutan Pathol

102

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“…Other cutaneous manifestations have been reported where the causal relationship with drug use is not clear, including cases of polyarteritis nodosa 122,123 and scleroderma. [124][125][126] Needle fragment foreign bodies after needle breakage are occasionally found in the skin. 13,58,127…”

Section: Miscellaneous Complicationsmentioning

confidence: 99%

Cutaneous complications of intravenous drug abuse

2004

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Injection drug abuse is a world-wide problem responsible for numerous minor to life-threatening and fatal complications. The skin is the tissue most evidently affected by intravenous drug addiction. A wide spectrum of cutaneous complications may occur in intravenous drug users. These include acute or delayed local complications, hypersensitivity reactions, cutaneous manifestations of systemic infections or becoming the site of toxigenic infections. Between 1996 and 2001, in our institution in south-eastern France, we observed cutaneous complications after crushed buprenorphine tablet injections in 13 patients. This paper reviews and classifies adverse effects of parenteral drug abuse on the skin.

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“…Case reports correlating cocaine use with skin lesions emerged first in the 1980s (18, 19). Since that time, palpable purpura; violaceous papules, bullae, and blisters; livedo racemosa with cutaneous necrosis; and multifocal necrotic lesions of the skin and muscle have been associated with cocaine use (4, 20–22).…”

Section: Differential Diagnosismentioning

confidence: 99%