title: Cocaine-induced thrombotic vasculopathy.
abstract: Cocaine has been associated with a number of cutaneous manifestations, and most reports in the literature have described cocaine-induced vasculitis. However, not all reactive patterns secondary to cocaine use are vasculitic in nature. Recently, there has been a disturbing trend of "cutting" cocaine with pharmacologically active substances, the most common being levamisole. This agent is known to cause serious adverse effects including agranulocytosis and cutaneous eruptions. The authors describe a 52-year-old woman who acutely developed an extensive bullous rash in the lower extremities after she snorted cocaine. The clinical, hematological and serological findings were suggestive of levamisole-induced vasculitis, but histopathology of the skin showed thrombogenic vasculopathy with no inflammatory infiltrate. A skin biopsy is an essential component in the diagnosis of cocaine-related syndromes and can aid in the distinction from true autoimmune vasculitis.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Ohio 44195, USA. johns@ccf.org
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.forename: Sudhir
authors.initials: S
authors.lastname: Manda
authors.forename: David
authors.initials: D
authors.lastname: Hamrock
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001706:Biopsy; D003042:Cocaine / Q000009:adverse effects*; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D008875:Middle Aged; D009820:Ohio; D011693:Purpura / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D012867:Skin / Q000473:pathology; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D007978:Levamisole; D003042:Cocaine