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Clinical Profile of Levamisole-Adulterated Cocaine-Induced Vasculitis/Vasculopathy: A 30-Case Series.
- Source :
-
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases [J Clin Rheumatol] 2019 Apr; Vol. 25 (3), pp. e16-e26. - Publication Year :
- 2019
-
Abstract
- Objectives: The aims of this study were to describe clinical and laboratory manifestations of patients with levamisole-adulterated cocaine-induced vasculitis/vasculopathy and to propose a skin classification according to the distribution and severity of lesions.<br />Methods: We report the characteristics of 30 patients admitted with levamisole-adulterated cocaine-induced vasculitis/vasculopathy in 4 high-complexity institutions in Colombia, from December 2010 to May 2017. We compare our findings with the main published series.<br />Results: Median age was 31 years (interquartile range, 27-38 years) with a male-to-female ratio of 5:1. Eighty-three percent of the patients had retiform purpura affecting the limbs, buttocks, face, or abdomen; 73% had ear necrosis, 50% cutaneous ulcers, 17% genital necrosis, 13% oral ulcers, and 10% digital necrosis. Cutaneous involvement was classified according to the frequency of the compromised corporal area, and purpuric lesions were stratified in 4 grades of severity. Anti-neutrophil cytoplasmic autoantibodies were positive in 85% of the cases, lupus anticoagulant in 73%, and antinuclear autoantibodies in 57%; rheumatoid factor was negative in all cases. We found nephritis in 17 cases (57%). Prednisolone was used in most of the patients (70%), with other immunosuppressive agents being used in a lower percentage. Improvement was observed in 93% of the patients, but symptoms recurred in 40%, attributed to relapses in consumption. End-stage chronic renal disease developed in 10% of the cases, and 1 patient died.<br />Conclusions: Because of rising cocaine consumption and levamisole adulteration frequency, levamisole-adulterated cocaine-induced vasculitis/vasculopathy is becoming more common. Detailed characterization of skin involvement coupled with multiple antibody positivity is essential for a diagnosis. Renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious.
- Subjects :
- Adjuvants, Pharmaceutic adverse effects
Adjuvants, Pharmaceutic pharmacology
Adult
Autoantibodies blood
Colombia
Dopamine Uptake Inhibitors pharmacology
Drug Contamination
Female
Humans
Male
Necrosis
Patient Care Management methods
Skin pathology
Treatment Outcome
Cocaine pharmacology
Cocaine-Related Disorders complications
Glomerulonephritis chemically induced
Glomerulonephritis diagnosis
Glomerulonephritis immunology
Glomerulonephritis therapy
Levamisole adverse effects
Levamisole pharmacology
Purpura chemically induced
Purpura diagnosis
Purpura immunology
Purpura therapy
Vasculitis chemically induced
Vasculitis diagnosis
Vasculitis immunology
Vasculitis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1536-7355
- Volume :
- 25
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
- Publication Type :
- Academic Journal
- Accession number :
- 29782427
- Full Text :
- https://doi.org/10.1097/RHU.0000000000000813