Cutaneous vasculopathy associated with cocaine use

Abstract

Objective. Cocaine is known to cause thrombotic complications. Its use has also been associated with a variety of rheumatologic manifestations, most notably cutaneous vasculopathy. We report clinical features and laboratory findings of cocaine-related cutaneous vasculopathy. Methods. Here we describe 8 patients with cocaine-related cutaneous vasculopathy.

Pyoderma gangrenosum–like facial ulcers in a woman associated with cocaine use and cANCA/anti-PR3+, pANCA/anti-MPO– serology

“…8 Three of 8 patients had involvement of the ear; 5 of 8 had involvement of the mouth. 8 All patients had positive pANCA, and 5 of 8 had cANCA positivity. Of note, no patient had positive cANCA (anti-PR3) coupled with negative pANCA (anti-MPO), as our patient had consistently.…”

“…Cocaine is a commonly abused drug in North America; its stimulatory effects are via blockage of norepinephrine and dopamine reuptake at the synaptic nerve endings. 8 It has both vasoconstrictive and procoagulant effects, raising the risk of vasculopathy development. Cocaine abuse has been associated with elevated inflammatory markers, cold agglutinin positivity, both pANCA and cANCA positivity, and hematologic abnormalities (eg, cytopenias).…”

“…Cocaine abuse has been associated with elevated inflammatory markers, cold agglutinin positivity, both pANCA and cANCA positivity, and hematologic abnormalities (eg, cytopenias). 8 Many reports associate levamisole as a suspected cause of vasculitis, vasculopathy, or direct skin necrosis. Although our patient was never directly found to be positive for levamisole biochemically, the high probability of cocaine and levamisole playing a role in the development, progression, and relapse of her disease cannot be ignored.…”

“…3 Levamisole has a half-life of approximately 5 hours, and may become undetectable in the urine in as little as 48 hours after exposure. 8 Traditionally, when levamisole was used as a therapeutic, known side effects included neutropenia, liver toxicity, gastrointestinal upset, and development of purpuric and necrotic lesions. 3 Cocaine, independent of levamisole, may itself be associated with development of autoimmunity; thus, both drugs may be contributing to development of ANCA-associated disease via the formation of neutrophil extracellular traps in susceptible individuals.…”

Cocaine-Associated Retiform Purpura

“…It was first reported in 2010. [4][5][6][7][8][9][10] The purpose of this study was to present 4 cases of cocaine-associated retiform purpura and to explore the pathophysiology of the microvascular changes, linking it with the known effects of cocaine and levamisole on the microvasculature. At one point it was thought to be exclusively attributable to cocaine.…”