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Text
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URL Address
<a href="http://doi.org/10.3121/cmr.2012.1085" target="_blank" rel="noreferrer noopener">http://doi.org/10.3121/cmr.2012.1085</a>
Pages
26–30
Issue
1
Volume
11
Dublin Core
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Title
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Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine.
Publisher
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Clinical Medicine & Research
Date
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2013
2013-02
Subject
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Male; Biopsy; Middle Age; Diagnosis; Differential; Skin Diseases; Drug Contamination; Powders; Toxicology; Anthelmintics – Adverse Effects; Anthelmintics – Blood; Anthelmintics – Urine; Cocaine – Adverse Effects; Ear – Pathology; Exanthema – Etiology; Knee – Pathology; Purpura – Etiology; Vascular – Chemically Induced; Vascular – Diagnosis; Vascular – Symptoms
Creator
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Huy Tran; Tan Debbie; Marnejon Thomas P
Description
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We report a case of cutaneous vasculopathy associated with the use of levamisole-adulterated cocaine. This recently described clinical entity is characterized by a purpuric rash with a predilection for the ears, leukopenia, and anti-neutrophilic cytoplasmic antibody (ANCA) positivity. It is estimated that more than 70% of the current United States cocaine supply is contaminated with levamisole. Levamisole is a widely available, inexpensive, white powder used as a 'cutting agent' in cocaine to expand volume and increase profits. It may also increase the euphoric and stimulatory effects of cocaine by increasing brain dopamine levels and producing amphetamine-like metabolites. Our patient exhibited a characteristic rash with involvement of the ears, leukopenia, and cocaine metabolites were detected in serum and urine. The presence of levamisole was confirmed in the urine utilizing gas chromatography-mass spectrometry. ANCA positivity was also present. Punch biopsy of the skin demonstrated vascular thrombosis and necrosis without true vasculitis. We review the literature for reported cases of cocaine- levamisole cutaneous vasculopathy syndrome, highlight the salient immunologic abnormalities, and contrast the features of this entity with idiopathic systemic vasculitis.
Identifier
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<a href="http://doi.org/10.3121/cmr.2012.1085" target="_blank" rel="noreferrer noopener">10.3121/cmr.2012.1085</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
2013
Anthelmintics – Adverse Effects
Anthelmintics – Blood
Anthelmintics – Urine
Biopsy
Clinical Medicine & Research
Cocaine – Adverse Effects
Diagnosis
Differential
Drug Contamination
Ear – Pathology
Exanthema – Etiology
Huy Tran
Knee – Pathology
Male
Marnejon Thomas P
Middle Age
Powders
Purpura – Etiology
Skin Diseases
Tan Debbie
Toxicology
Vascular – Chemically Induced
Vascular – Diagnosis
Vascular – Symptoms