For this investigation, researchers wanted to characterize the clinical and laboratory signs of levamisole-adulterated cocaine-induced vasculitis/vasculopathy in patients and to suggest a skin categorization based on the location and severity of lesions. From December 2010 to May 2017, 30 patients with levamisole-adulterated cocaine-induced vasculitis/vasculopathy were hospitalized to four high-complexity Colombian hospitals. They compared the results to the major published series. The median age was 31 years (interquartile range, 27–38 years), with a 5:1 male-to-female ratio. Eighty-three percent of the patients exhibited retiform purpura affecting the limbs, buttocks, face, or belly; 73% had ear necrosis, 50% had cutaneous ulcers, 17% had genital necrosis, 13% had mouth ulcers, and 10% had digital necrosis. Cutaneous involvement was graded based on the frequency of the compromised corporal region, and purpuric lesions were divided into four severity levels. Antineutrophil cytoplasmic autoantibodies were found in 85% of the patients, lupus anticoagulant in 73%, and antinuclear autoantibodies in 57%; rheumatoid factor was found to be negative in all instances. In 17 cases (57%), scientists discovered nephritis. Prednisolone was utilized in 70% of the patients, with additional immunosuppressive medications used in a smaller number. Improvement was shown in 93% of the patients, however, symptoms returned in 40%, which was related to relapses in drinking. In 10% of the patients, the end-stage chronic renal disease occurred, and one patient died.
Because of the increased prevalence of levamisole adulteration and cocaine intake, levamisole-adulterated cocaine-induced vasculitis/vasculopathy is becoming increasingly prevalent. A detailed description of skin involvement, together with numerous antibody positives, is required for a diagnosis. Renal involvement is common, clinically and histologically diverse, and possibly fatal.
Reference:journals.lww.com/jclinrheum/Abstract/2019/04000/Clinical_Profile_of_Levamisole_Adulterated.8.aspx
