title: Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients.
abstract: BACKGROUND
  Recently, isolated reports of pyoderma gangrenosum (PG) secondary to levamisole-contaminated cocaine have been described, with similar serologic findings to the vasculopathic presentation.
  
  
  OBJECTIVE
  We sought to describe clinical, histopathological, and serologic findings in 8 patients with PG associated with levamisole-contaminated cocaine.
  
  
  METHODS
  Eight consecutive patients presenting with this disease spanning the period from 2011 to 2015 were included for the cohort. Observed variables included: lesion distribution, morphology, serologic titers, and histopathologic evaluation for vasculitis and vasculopathy.
  
  
  RESULTS
  All patients reported cocaine exposure prior to the onset of lesions resembling PG. Lesions appeared primarily on the upper (6 of 8 patients) and lower (all 8 patients) extremities. Most patients demonstrated elevated titers for p-ANCA and antiphospholipid antibodies, and a diffuse dermal infiltrate dominated by neutrophils was seen in all biopsy specimens. Lesions improved or remained stable with conservative management or short courses of steroids, and recurrence was only noted on re-exposure to adulterated cocaine.
  
  
  CONCLUSIONS
  The study is limited by sample size.
  
  
  CONCLUSIONS
  PG may occur after exposure to levamisole-adulterated cocaine. Clinical and histopathological findings resemble those seen in conventional forms of PG, whereas serologic findings mirror those seen in other levamisole-associated vasculopathic or vasculitic eruptions. Cocaine avoidance represents a cornerstone of management in these patients.
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Haneol S
authors.initials: HS
authors.lastname: Jeong
authors.affiliation: Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium, Dermatology Residency Program, San Antonio, Texas.
authors.forename: Heather
authors.initials: H
authors.lastname: Layher
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Lauren
authors.initials: L
authors.lastname: Cao
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Travis
authors.initials: T
authors.lastname: Vandergriff
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: arturo.dominguez@utsouthwestern.edu.
authors.forename: Arturo R
authors.initials: AR
authors.lastname: Dominguez
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003042:Cocaine / Q000009:adverse effects*; D015331:Cohort Studies; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007978:Levamisole / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017511:Pyoderma Gangrenosum / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007978:Levamisole; D003042:Cocaine
keywords: cocaine; dermatosis; immunologic markers; levamisole; pyoderma gangrenosum