Cutaneous Vasculopathy and Neutropenia Associated With Levamisole-Adulterated Cocaine
The American Journal of the Medical SciencesPublished 30 October 2012
Natasha Purai Arora
Citations36
SJR quartileQ2
SJR score0.67
SNIP0.74
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TL;DR
Levamisole-induced cutaneous vasculopathy in cocaine users is characterized by a female predominance, a retiform purpuric rash with a predilection for lower extremities, autoantibody production, leukopenia and/or neutropenia and recurrences with future cocaine use.
Abstract
Levamisole-induced cutaneous vasculopathy in cocaine users is characterized by a female predominance, a retiform purpuric rash with a predilection for lower extremities, autoantibody production, leukopenia and/or neutropenia and recurrences with future cocaine use.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
Substance Abuse and Mental Health Services Administration
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A new cutaneous vasculitis syndrome due to cocaine contaminated with the adulterant levamisole is reported, which can be recognized by its characteristic rash and skin pathology, together with leukopenia and autoantibody production.
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1 Straub, H,_Journal of Physiology, 1910, 40, 378.
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This diagnosis should be strongly considered in patients with a history of cocaine abuse who present with a tetrad of cutaneous manifestations consisting of palpable purpura or bullae with ear involvement, arthralgias, leukopenia, and positive ANCA in high titers and negative Antimyeloperoxidase, when other infectious or idiopathic vasculitic entities have been excluded.
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