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cocaine-levamisole-induced cutaneous vasculitis
Etiology:
- cocaine abuse, cocaine cut with veterinary antihelmintic levamisole
Pathology:
- inhaled levamisole in cocaine is associated with cutaneous vasculitis
Clinical manifestations:
- palpable purpura or bullae with ear involvement
- oral mucosal ulceration
- arthralgias
Laboratory:
- complete blood count (CBC)
- leukopenia, neutropenia
- positive cANCA in serum in high titers
- variable myeloperoxidase Ab in serum (p-ANCA)
Management:
- NSAIDS 1st-line for arthralgias
- colchicine & systemic glucocorticoid to manage severe & persistent skin lesions
General
vasculitis
References
- Poon SH, Baliog CR Jr, Sams RN et al
Syndrome of cocaine-levamisole-induced cutaneous vasculitis
and immune-mediated leukopenia.
Semin Arthritis Rheum. 2011 Dec;41(3):434-44.
PMID: 21868067