Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients

Jeong, Haneol S.; Layher, Heather; Cao, Lauren; Vandergriff, Travis; Domínguez, Arturo R.

doi:10.1016/j.jaad.2015.11.040

Cited by 37 publications

(52 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The manifestations of habitual cocaine use can mimic tumors, infections, and immunologic diseases and can affect multiple organs, causing nasal septal perforation, cutaneous vasculitis, vasculopathic skin necrosis, pyoderma gangrenosum (PG), 1 and lung disease 2 . Levamisole is a veterinary antiparasitic drug often added to cocaine in the United States to cheaply enhance or extend cocaine's euphoric effects.…”

Section: Introductionmentioning

confidence: 99%

“…Levamisole is a veterinary antiparasitic drug often added to cocaine in the United States to cheaply enhance or extend cocaine's euphoric effects. It is present in about 70% of seized cocaine in the United States, and it is believed to play a direct role in induction of vasculopathy, vasculitis, and PG 1 . Early distinction of these disorders can be challenging.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user

et al. 2017

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user

et al. 2017

View full text Add to dashboard Cite

“…Systemic therapy-such as corticosteroids, immunosuppressive therapy or even biological therapy-is needed to achieve remission in cases of extensive PG; cessation of cocaine use is also imperative. 5 he never completed treatment cycles for longer than three weeks. After one year, the patient was lost to follow-up.…”

mentioning

confidence: 98%

Multiple Pyoderma Gangrenosum Ulcers Associated with Cocaine Abuse

Ruiz‐Villaverde¹,

Cano²

2016

SQUMJ

View full text Add to dashboard Cite

A 38-year-old male was admitted to the Department of Dermatology, Complejo Hospitalario de Granada, Granada, Spain, in 2016 with inflamed papules, plaques and nodules in the armpits, chest, pubis and lumbar region [ Figure 1]. He had a history of poorly-controlled type 2 diabetes, which was being treated with insulin, and dyslipidaemia, treated with 40 mg of simvastatin per day. The skin lesions were associated with abscess formation and spontaneous drainage. The patient acknowledged a past history of cocaine abuse, but denied any recent drug use. The results of a laboratory work-up were normal, including a complete blood count, general biochemistry tests, an autoimmune profile, an antinuclear antibody panel, a lupus anticoagulant and cryoglobulin work-up, a C-reactive protein test, complement levels and erythrocyte sedimentation rate. The patient tested negative for hepatitis B, hepatitis C and human immunodeficiency virus infections. A computed tomography scan showed neither pulmonary nor abdominal anomalies. Cutaneous tissue cultures for bacteria, fungi and mycobacteria were all negative. The initial differential diagnosis included cutaneous chronic lupus and atypical mycobacteriosis.An excisional biopsy was performed on an active lesion on the right side of the chest. Histopathology revealed a dense neutrophilic inflammatory infiltrate involving the entire dermis, without granulomas or vasculitis [ Figure 2]. Direct immunofluorescence testing was negative. Urine toxicology screening was positive for cocaine and levamisole. As a result of the clinical and pathological findings, a diagnosis of pyoderma gangrenosum (PG) was made. The patient was advised to stop using cocaine and was prescribed prednisone at a dose of 60 mg daily for a month, reduced by 5 mg per week until cessation. Unfortunately, due to patient noncompliance, optimal control of the dermatological condition could not be achieved. Continued use of cocaine resulted in ongoing PG flare-ups. The patient was subsequently prescribed 0.5 mg/kg/day of prednisone, although interesting medical image

show abstract

“…Levamisole, a common adulterant in cocaine, can produce skin lesions similar to those described by Haskin and colleagues 5, 6, 7. The US Drug Enforcement Agency has found levamisole in some samples of seized heroin 8 .…”

mentioning

confidence: 60%

Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients

Cited by 37 publications

References 10 publications

Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user

Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user

Multiple Pyoderma Gangrenosum Ulcers Associated with Cocaine Abuse

Commentary on “A new drug with a nasty bite: A case of krokodil-induced skin necrosis in an intravenous drug user”

Contact Info

Product

Resources

About