Cocaine-induced vasculitis: is this a new trend?

Miraida Reneé García Pérez,1 Vanessa L Ortiz-González,1 Maria Betancourt,1 Rogelio Mercado21Department of Internal Medicine, San Juan City Hospital, 2Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto RicoAbstract: Co...

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Autores principales:	Garc&iacute;a P&eacute;rez MR, Ortiz-Gonz&aacute;lez VL, Betancourt M, Mercado R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/8f771abfc3a94b2583fe22bfad417969
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spelling	oai:doaj.org-article:8f771abfc3a94b2583fe22bfad4179692021-12-02T06:32:28ZCocaine-induced vasculitis: is this a new trend?1179-156Xhttps://doaj.org/article/8f771abfc3a94b2583fe22bfad4179692013-10-01T00:00:00Zhttp://www.dovepress.com/cocaine-induced-vasculitis-is-this-a-new-trend-a14590https://doaj.org/toc/1179-156XMiraida Reneé García Pérez,1 Vanessa L Ortiz-González,1 Maria Betancourt,1 Rogelio Mercado21Department of Internal Medicine, San Juan City Hospital, 2Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto RicoAbstract: Cocaine-induced vasculitis is a rare complication found in drug abusers. It occurs due to cocaine adulterated with levamisole. Levamisole was once used as a chemotherapy and immunomodulator for different conditions. One of the side effects of this medication is necrotizing vasculitis which has been reported in the US and Puerto Rico. Here we present another case of cocaine induced vasculitis in Puerto Rico. We describe a 43-year-old female with past medical history of bronchial asthma, migraine, and crack smoking who presented to the emergency room due to blood in her urine for 5 days. She also reported fever, chills, and fatigue. At the physical exam she had a right knee ulcer with swelling erythema, warmth, and pain. Also, she had retiform purpuric plaque lesions in her ears, bilaterally. Eroded plaques with elevated borders at left foot and finger dorsum were also present. Laboratory workup was positive for cocaine. The patient showed leucopenia and microcytic anemia with a normal absolute neutrophil count in her cell blood count. Blood cultures, urine cultures, and ulcer cultures were negative. Urinalysis was positive for proteinuria and hematuria. Also, the patient had positive perinuclear anti-neutrophil cytoplasmic antibody, cytoplasmic anti-neutrophil cytoplasmic antibody, and antinuclear antibody tests and elastase specificity. She showed negative anticardiolipin and lupus anticoagulant antibodies. Her complement levels were decreased. The punch biopsy of her ear showed superficial thrombosis of superficial vascular plexus with perivascular lymphocytic infiltrates and deeper sections showed epidermal necrosis and necrotizing vasculitis. She was started on a high dose of steroids, but could not complete the treatment because she escaped from the hospital before finishing her treatment.Keywords: levamisole, cocaine-induced vasculitis, vasculitis, P-ANCA, C-ANCAGarc&iacute;a P&eacute;rez MROrtiz-Gonz&aacute;lez VLBetancourt MMercado RDove Medical PressarticleDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol 2013, Iss default, Pp 77-80 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the musculoskeletal system RC925-935
spellingShingle	Diseases of the musculoskeletal system RC925-935 Garc&iacute;a P&eacute;rez MR Ortiz-Gonz&aacute;lez VL Betancourt M Mercado R Cocaine-induced vasculitis: is this a new trend?
description	Miraida Reneé García Pérez,1 Vanessa L Ortiz-González,1 Maria Betancourt,1 Rogelio Mercado21Department of Internal Medicine, San Juan City Hospital, 2Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto RicoAbstract: Cocaine-induced vasculitis is a rare complication found in drug abusers. It occurs due to cocaine adulterated with levamisole. Levamisole was once used as a chemotherapy and immunomodulator for different conditions. One of the side effects of this medication is necrotizing vasculitis which has been reported in the US and Puerto Rico. Here we present another case of cocaine induced vasculitis in Puerto Rico. We describe a 43-year-old female with past medical history of bronchial asthma, migraine, and crack smoking who presented to the emergency room due to blood in her urine for 5 days. She also reported fever, chills, and fatigue. At the physical exam she had a right knee ulcer with swelling erythema, warmth, and pain. Also, she had retiform purpuric plaque lesions in her ears, bilaterally. Eroded plaques with elevated borders at left foot and finger dorsum were also present. Laboratory workup was positive for cocaine. The patient showed leucopenia and microcytic anemia with a normal absolute neutrophil count in her cell blood count. Blood cultures, urine cultures, and ulcer cultures were negative. Urinalysis was positive for proteinuria and hematuria. Also, the patient had positive perinuclear anti-neutrophil cytoplasmic antibody, cytoplasmic anti-neutrophil cytoplasmic antibody, and antinuclear antibody tests and elastase specificity. She showed negative anticardiolipin and lupus anticoagulant antibodies. Her complement levels were decreased. The punch biopsy of her ear showed superficial thrombosis of superficial vascular plexus with perivascular lymphocytic infiltrates and deeper sections showed epidermal necrosis and necrotizing vasculitis. She was started on a high dose of steroids, but could not complete the treatment because she escaped from the hospital before finishing her treatment.Keywords: levamisole, cocaine-induced vasculitis, vasculitis, P-ANCA, C-ANCA
format	article
author	Garc&iacute;a P&eacute;rez MR Ortiz-Gonz&aacute;lez VL Betancourt M Mercado R
author_facet	Garc&iacute;a P&eacute;rez MR Ortiz-Gonz&aacute;lez VL Betancourt M Mercado R
author_sort	Garc&iacute;a P&eacute;rez MR
title	Cocaine-induced vasculitis: is this a new trend?
title_short	Cocaine-induced vasculitis: is this a new trend?
title_full	Cocaine-induced vasculitis: is this a new trend?
title_fullStr	Cocaine-induced vasculitis: is this a new trend?
title_full_unstemmed	Cocaine-induced vasculitis: is this a new trend?
title_sort	cocaine-induced vasculitis: is this a new trend?
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/8f771abfc3a94b2583fe22bfad417969
work_keys_str_mv	AT garcampiacuteapampeacuterezmr cocaineinducedvasculitisisthisanewtrend AT ortizgonzampaacutelezvl cocaineinducedvasculitisisthisanewtrend AT betancourtm cocaineinducedvasculitisisthisanewtrend AT mercador cocaineinducedvasculitisisthisanewtrend
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Cocaine-induced vasculitis: is this a new trend?

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