Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine.

Title

Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine.

Creator

Huy Tran; Tan Debbie; Marnejon Thomas P

Publisher

Clinical Medicine & Research

Date

2013
2013-02

Description

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.

Subject

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

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

26–30

Issue

1

Volume

11

Citation

Huy Tran; Tan Debbie; Marnejon Thomas P, “Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine.,” NEOMED Bibliography Database, accessed May 9, 2021, https://neomed.omeka.net/items/show/5918.

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