title: Photoletter to the editor: Diffuse cocaine-related purpura.
abstract: Diffuse purpura is an uncommon skin manifestation found in platelet and coagulation disorders, meningococcemia, vasculitides and cocaine use. Reports of cocaine-related purpura predominantly involve adulteration with the anti-helminthic, levamisole. Levamisole enhances the effects of cocaine and is known to cause vasculitis. Recently, the CDC also released an advisory of oxymorphone being used intravenously causing thrombogenic thrombocytopenic purpura (TTP). We report the case of a patient with diffuse purpura ultimately diagnosed with cocaine-related thrombogenic vasculopathy. In the current environment of adulterated cocaine usage and increased prescription narcotic abuse, it is crucial to investigate substance abuse as a cause of diffuse purpura.
authors.affiliation: University of Tennessee Medical Center, Department of Emergency Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Debjeet
authors.initials: D
authors.lastname: Sarkar
authors.affiliation: University of Tennessee Medical Center, Department of Emergency Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Hussein A
authors.initials: HA
authors.lastname: Kammona
authors.affiliation: University of Tennessee Medical Center, Department of Emergency Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Lamsen
authors.affiliation: University of Tennessee Medical Center, Department of Emergency Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Bradley A
authors.initials: BA
authors.lastname: McAbee
authors.affiliation: University of Tennessee Medical Center, Department of Pathology, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Clark
authors.affiliation: University of Tennessee Medical Center, Department of Pathology, 1924 Alcoa Highway, Knoxville, TN 37920, USA;
authors.forename: Solomon S
authors.initials: SS
authors.lastname: Lee
authors.affiliation: University of TennesseeMedical Center, Department of Internal Medicine, 1924 Alcoa Highway, Knoxville, TN 37920, USA.
authors.forename: Shane E
authors.initials: SE
authors.lastname: Kelley
keywords: cocaine; levamisole; oxymorphone; purpura