NDLI: Levamisole-induced leukocytoclastic vasculitis and neutropenia in a patient with cocaine use: An extensive case with necrosis of skin, soft tissue, and cartilage

Content Provider	Springer Nature : BioMed Central
Author	Arora, Natasha Purai Jain, Tania Bhanot, Ravinder Natesan, Suganthini Krishnan
Abstract	Levamisole-induced vasculitis is a relatively new entity in people who use cocaine. We describe a 44-year-old woman with a history of cocaine use who presented with a complaint of a painful rash of 2-3 month’s duration on her extremities, cheeks, nose, and earlobes. She had not experienced fever, weight loss, alopecia, dry eyes, oral ulcers, photosensitivity, or arthralgia. Examination revealed tender purpuric eruptions with central necrosis on her nose, cheeks, earlobes, and extremities. Laboratory investigations revealed neutropenia, an elevated erythrocyte sedimentation rate (ESR), presence of lupus anticoagulant, low complement component 3 (C3), and presence of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA). A urine toxicology screen was positive for cocaine, and gas chromatography–mass spectrometry was positive for levamisole. Skin biopsy showed leukocytoclastic vasculitis and small vessel thrombosis. Necrotic lesions of the nose led to its self-amputation. Large bullae on the lower extremities ruptured, leading to wound infection and extensive necrosis that required multiple surgical debridements. When necrosis progressed despite debridement, bilateral above-knee amputation of the legs was performed. Once new lesions stopped appearing, the patient was discharged home. Two months later, she had a recurrence related to cocaine use. To the best of our knowledge, this is only the second reported case of levamisole-induced vasculitis that required above-knee amputation.
Related Links	https://ascpjournal.biomedcentral.com/counter/pdf/10.1186/1940-0640-7-19.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	19400640
DOI	10.1186/1940-0640-7-19
Journal	Addiction Science & Clinical Practice
Issue Number	1
Volume Number	7
Language	English
Publisher	BioMed Central
Publisher Date	2012-09-24
Access Restriction	Open
Subject Keyword	Public Health Pharmacology Toxicology Psychopharmacology Health Psychology Social Work Levamisole Cutaneous vasculitis Retiform purpura Leukocytoclastic vasculitis Pharmacology/Toxicology
Content Type	Text
Resource Type	Case study
Subject	Psychiatry and Mental Health Clinical Psychology
Journal Impact Factor	3.7/2023
5-Year Journal Impact Factor	4.2/2023

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