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Sánchez-Puigdollers A, Just-Sarobé M, Pastor-Jané L. Cutaneous and Mucosal Conditions Associated With Cocaine Use. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:125-131. [PMID: 36115385 DOI: 10.1016/j.ad.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/25/2022] [Accepted: 09/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments.
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Affiliation(s)
| | - M Just-Sarobé
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, España
| | - L Pastor-Jané
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, España
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Sánchez-Puigdollers A, Just-Sarobé M, Pastor-Jané L. [Translated article] Cutaneous and Mucosal Conditions Associated With Cocaine Use. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T125-T131. [PMID: 36470395 DOI: 10.1016/j.ad.2022.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 12/12/2022] Open
Abstract
Cocaine and some of its main adulterants, such as levamisole, can cause multiple cutaneous and mucosal manifestations, including ischemic complications, neutrophilic dermatoses, midline destructive lesions, and vasculitis associated with antineutrophil cytoplasmic antibodies (ANCAs). Striking systemic symptoms are generally not seen. In all these conditions, positive test results may be observed for antinuclear antibodies, antiphospholipid antibodies, and various ANCAs, sometimes with characteristic staining patterns. Histology typically shows vascular changes, such as leukocytoclastic vasculitis, necrotizing vasculitis, and thrombi. We review the clinical, serologic, and histologic features of cutaneous and mucosal conditions associated with the use of cocaine and also look at pathophysiologic mechanisms, differential diagnoses, and treatments.
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Affiliation(s)
| | - M Just-Sarobé
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - L Pastor-Jané
- Servicio de Dermatología, Hospital Universitari Joan XXIII, Tarragona, Spain
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Keim CK, Schwartz RA, Kapila R. Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes. Arch Dermatol Res 2023; 315:265-273. [PMID: 34807290 PMCID: PMC8607060 DOI: 10.1007/s00403-021-02303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/11/2021] [Indexed: 10/28/2022]
Abstract
Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura.
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Affiliation(s)
- Catherine K. Keim
- grid.430387.b0000 0004 1936 8796Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Robert A. Schwartz
- grid.430387.b0000 0004 1936 8796Dermatology and Pathology, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
| | - Rajendra Kapila
- grid.430387.b0000 0004 1936 8796Infectious Diseases, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ 07103 USA
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Sbroglio LL, Maiolini VM, Rabelo IMMA, Giraldelli GA, Tuccori LP, Cunha RG. Mucocutaneous leishmaniasis in a cocaine user: diagnostic and therapeutic knowledge. Rev Soc Bras Med Trop 2020; 53:e20200040. [PMID: 32578710 PMCID: PMC7310364 DOI: 10.1590/0037-8682-0040-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.
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Affiliation(s)
- Lissiê Lunardi Sbroglio
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Dermatologia, Rio de Janeiro, RJ, Brasil
| | - Viviane Maria Maiolini
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Dermatologia, Rio de Janeiro, RJ, Brasil
| | | | - Gabriela Almeida Giraldelli
- Universidade do Estado do Rio de Janeiro, Programa de Pós-Graduação em Dermatologia, Rio de Janeiro, RJ, Brasil
| | - Luciana Patrícia Tuccori
- Universidade do Estado do Rio de Janeiro, Programa de Residência Médica em Infectologia, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Guimarães Cunha
- Universidade do Estado do Rio de Janeiro, Departamento de Infectologia, Rio de Janeiro, RJ, Brasil
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A case series and literature review on patients with rhinological complications secondary to the use of cocaine and levamisole. The Journal of Laryngology & Otology 2020; 134:440-446. [PMID: 32431257 DOI: 10.1017/s0022215120000894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients. METHODS A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out. RESULTS Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion. CONCLUSION As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
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Estébanez A, Silva E, Abdilla N. Ulcerative pyoderma gangrenosum associated with cocaine use. Med Clin (Barc) 2020; 154:373-374. [PMID: 31113658 DOI: 10.1016/j.medcli.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Estébanez
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España.
| | - Esmeralda Silva
- Servicio de Dermatología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - Noelia Abdilla
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
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Abstract
BACKGROUND Levamisole is an immunomodulatory medication previously used to treat rheumatoid arthritis and some types of cancers; it was banned for use in humans in 2000 owing to its harmful side effects. Use of levamisole-laced cocaine is associated with a life-threatening syndrome characterized by a necrotizing purpuric rash leading to tissue destruction and necrotic wounds. This Clinical Challenges article summarizes our experience with the care of 2 adult women diagnosed with levamisole-related vasculitis. CASE Case 1 is a 46-year-old woman who presented with joint pain in her hands and legs, along with bilateral ear pain, swelling, and bleeding. She was initially diagnosed with vasculitis and possible systemic lupus erythematosus. She experienced multiple recurrences and exacerbation of her condition over a period of months. She was ultimately diagnosed with levamisole-related vasculitis from recurrent cocaine use resulting in bilateral above the knee amputations. The second case is a 50-year-old woman who presented to our emergency department with redness and swelling of her bilateral lower extremities. She developed blisters and pustules that rapidly evolved into abscesses and red lesions over the course of several months. Her wounds also deteriorated despite topical therapy that occurred in a context of recurring use of cocaine. CONCLUSIONS Our experience with these cases suggests that WOC nurses should consider levamisole-induced vasculitis in all patients presenting with unexplained vasculitis-type lesions, and particularly when these lesions occur in the context of known or suspected use of illicit substances such as cocaine. Given the absence of clinical guidelines for this increasingly prevalent condition, we recommend wound care based on principles of moist wound healing, combined with judicious use of therapies with antimicrobial activity and nonadherent dressings to reduce pain. Finally, we strongly recommend that care of these patients occurs as one part of a multidisciplinary care approach that focuses on cessation of the use of cocaine and all other illicit substances.
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Jiménez-Zarazúa O, Guzmán-Ramírez A, Vélez-Ramírez LN, López-García JA, Casimiro-Guzmán L, Mondragón JD. A Case of Acute Pemphigus Vulgaris Relapses Associated with Cocaine Use and Review of the Literature. Dermatol Ther (Heidelb) 2018; 8:653-663. [PMID: 30415373 PMCID: PMC6261113 DOI: 10.1007/s13555-018-0271-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is a bullous autoimmune disease that affects the skin and mucous membranes. It is very difficult to establish the etiology and the triggering factors that influence reactivations in pemphigus vulgaris (PV). The case of a 33-year-old male with chronic history of intranasal cocaine consumption is presented in this report. We present the clinical case of the patient, followed for a total of 86 weeks, with ten relapses secondary to probable cocaine use. The patient was admitted to the emergency department after presenting polymorphic dermatosis characterized by blisters, vesicles, and excoriations extending from the oral cavity to the thorax, and to the inguinal and genital regions, affecting approximately 35 % of the body surface area with a score of 56 on the Pemphigus Skin Disorder Index. Skin biopsies were compatible with PV diagnosis. The patient had clinical improvement with a combination of methylprednisolone 500 mg intravenously (IV) and cyclophosphamide 500 mg IV every 15 days, along with prednisone 50 mg orally (PO) q24 h and mycophenolic acid 500 mg PO q6 h. Persistent cocaine use is highly likely to be the factor triggering lesion reactivation and responsible for the torpid evolution. We cannot definitively conclude whether the change from azathioprine to mycophenolic acid after the tenth relapse was the adjuvant medication responsible for the end of the consolidation phase and complete remission on therapy. This case study could potentially serve as a guide for management of patients who continuously persist with cocaine use, leading to a clinical picture refractory to multiple therapeutic schemes.
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Affiliation(s)
- Omar Jiménez-Zarazúa
- Department of Internal Medicine, Hospital General León, León, Guanajuato, Mexico.,Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | | | | | - Jesús A López-García
- Head of the Department of Internal Medicine and Rheumatology, Hospital General León, León, Guanajuato, Mexico
| | | | - Jaime D Mondragón
- Department of Neurology, Alzheimer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Marta Nataya SM, Cristina HA, Luis TM. An unusual case of distal necrosis. Looking for the truth. Eur J Intern Med 2018; 52:e3-e4. [PMID: 28864158 DOI: 10.1016/j.ejim.2017.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/14/2017] [Indexed: 11/27/2022]
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Marquez J, Aguirre L, Muñoz C, Echeverri A, Restrepo M, Pinto LF. Cocaine-Levamisole-Induced Vasculitis/Vasculopathy Syndrome. Curr Rheumatol Rep 2017; 19:36. [DOI: 10.1007/s11926-017-0653-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Consumidores de cocaína y manifestaciones cutáneo-mucosas. Med Clin (Barc) 2017; 148:e1. [DOI: 10.1016/j.medcli.2016.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
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