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Syndrome of Cocaine-Levamisole-Induced Cutaneous Vasculitis and Immune-Mediated Leukopenia
Seminars in Arthritis and Rheumatism, 08/29/2011
Poon SH et al. – Cocaine–levamisole–related cutaneous vasculitis with leukopenia is a diagnosis of exclusion, but this diagnosis should be strongly considered in patients with a history of cocaine abuse who present with a tetrad of cutaneous manifestations consisting of palpable purpura or bullae with ear involvement, arthralgias, leukopenia, and positive antineutrophil cytoplasmic antigen (ANCA) in high titers and negative Antimyeloperoxidase, when other infectious or idiopathic vasculitic entities have been excluded.
Methods- Cases were seen and reviewed in both the inpatient consult service and the outpatient clinics at Rhode Island Hospital from August 2009 to August 2010.
- Clinical characteristics as well as pertinent laboratory parameters were also reviewed and corroborated with a review of the present literature.
- The authors describe 3 cases of cocaine–levamisole–related cutaneous vasculitis with or without associated neutropenia, and 1 case of severe neutropenia with oral mucosal ulceration.
- Further serologic studies revealed maximum titers of ANCA mostly in a perinuclear pattern.
- Antimyeloperoxidase tested negative or mildly elevated in the cohort.
- Three patients with neutropenia had positive antigranulocyte IgM antibody.
- Nonsteroidal anti–inflammatory drugs were effective as first–line treatment for joint pain.
- The use of colchicine and systemic corticosteroid was employed to manage severe and persistent skin lesions.