Myocardial infarction in a young man with antiphospholipid syndrome and cocaine use

Williams, Emily L.; Endean, Alison; Edwards, C.

doi:10.1177/0961203307077670

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…Cocaine users are more likely to produce aPL (13). It is generally believed that patients with the combination of aPL and history of cocaine use are at a particularly high risk of thrombotic complications (13,14). In addition, it was suggested that IgM anticardiolipin antibodies in particular predispose cocaine users to medical complications (13).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous vasculopathy associated with cocaine use

Milman

Smith

2011

Arthritis Care & Research

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Section: Discussionmentioning

confidence: 99%

Cutaneous vasculopathy associated with cocaine use

Milman

Smith

2011

Arthritis Care & Research

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“…In addition, C5b-9 directly enhances apoptosis. It is known that patients with cocaine-associated retiform purpura have a very distinctive autoreactive antibody profile, specifically in regard to antibodies to phospholipids [40][41][42][43] and antibodies to neutrophilic cytoplasmic-based proteins. We have shown in a separate study that eculizumab directly reduces the extent of apoptosis, hence indicative of the effect of C5b-9 as an independent determinant of apoptosis.…”

Section: Discussionmentioning

confidence: 99%

“…A further mechanism of endothelial cell apoptosis is one related to activation of activated protein 1 31-34 and nuclear factor-kappa B through the release of tumor necrosis factor (TNF)-a by cocaine-free radicals. [40][41][42][43] Hence, with apoptosis, those inner cytoplasmic membranebased phospholipids become displaced to the surface, creating a state of neoantigenicity with secondary antiphospholipid antibody formation. Apoptosis either through C5b-9 deposition or the direct effects of cocaine in promoting the release of TNF-a leads to epitope spreading with the induction of neoantigens.…”

Section: Discussionmentioning

confidence: 99%

Cocaine-Associated Retiform Purpura

Magro

Wang

2013

The American Journal of Dermatopathology

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Cocaine-associated retiform purpura is a recently described entity characterized by striking hemorrhagic necrosis involving areas of skin associated with administration of cocaine. Levamisole, an adulterant in cocaine, has been suggested as the main culprit pathogenetically. Four cases of cocaine-associated retiform purpura were encountered in the dermatopathology practice of C. M. Magro. The light microscopic findings were correlated with immunohistochemical and immunofluorescence studies. All 4 cases showed a very striking thrombotic diathesis associated with intravascular macrophage accumulation. Necrotizing vasculitis was noted in 1 case. Striking intercellular adhesion molecule-1 (ICAM-1)/CD54 expression in vessel wall along with endothelial expression of caspase 3 and extensive vascular C5b-9 deposition was observed in all biopsies examined. Cocaine-induced retiform purpura is a C5b-9-mediated microvascular injury associated with enhanced apoptosis and prominent vascular expression of ICAM-1, all of which have been shown in prior in vitro and in vivo murine models to be a direct effect of cocaine metabolic products. Antineutrophilic cytoplasmic antibody and antiphospholipid antibodies are likely the direct sequelae of the proapoptotic microenvironment. The inflammatory vasculitic lesion could reflect the downstream end point reflective of enhanced ICAM-1 expression and the development of antineutrophilic cytoplasmic antibody. Levamisole likely works synergistically with cocaine in the propagation of this syndromic complex.

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“…We have recently described a case of MI in a young man with APS who ingested cocaine. A vasoconstrictive stimulus, and pro-coagulant state, combined to produce coronary artery occlusion [18]. An interesting observation has been the diagnosis of syndrome X in nine of our patients to date [19].…”

Section: Heartmentioning

confidence: 97%

Hughes syndrome (the antiphospholipid syndrome): 25 years old

Edwards¹,

Hughes

2008

Mod Rheumatol

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The antiphospholipid (Hughes) syndrome (APS) is a unique thrombotic disorder, causing both arterial and venous thrombosis, linked to the presence of antibodies directed against phospholipid-protein complexes. The first papers describing the syndrome were published in 1983 and, over the next two years, a series of publications described in detail the various clinical manifestations of the syndrome. Laboratory standardisation workshops were also set up and, in 1984, the first "world" symposium on APS was held. The international APS conferences have continued to grow in numbers and in stature. The APS has already had an impact in obstetrics, in medicine, in psychiatry, and in surgery. The approximate figure of 1 in 5 is a useful guide -- 1 in 5 of all young strokes, 1 in 5 recurrent miscarriages, 1 in 5 DVTs. More precise data will become available in the worlds of epilepsy, migraine, Alzheimer's, and MS. The advent of newer "biologic" immunosuppressives such as rituximab may offer help in selected cases. Intravenous immunoglobulin has proved successful, especially in the emergency setting.

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Myocardial infarction in a young man with antiphospholipid syndrome and cocaine use

Cited by 4 publications

References 12 publications

Cutaneous vasculopathy associated with cocaine use

Cutaneous vasculopathy associated with cocaine use

Cocaine-Associated Retiform Purpura

Hughes syndrome (the antiphospholipid syndrome): 25 years old

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