Levamisole abuse
- PDF / 170,667 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 5 Downloads / 152 Views
1 S
Pyoderma gangrenosum: 2 case reports In a report, a 64-year-old man and a 46-year-old man were described, who developed pyoderma gangrenosum (PG) or PG flare following abuse of levamisole-adulterated cocaine [dosages not stated; not all routes stated]. Case 1: The 64-year-old man presented with multiple painful ulcers (up to 10cm in diameter) with undermined and violaceous raised borders for 1 month. These lesions were on the lower leg, intranasal cavity and trunk with several necrotic and crusted plaques. He was suspected to have PG. Further investigations were performed to rule out malignancies. He had a history of cardiac and peripheral atherosclerotic disease, atrial fibrillation, diabetes and chronic renal failure. Skin biopsy demonstrated a large abscesses in the dermis, which was surrounded by a mixed inflammatory infiltrates (macrophages, lymphocytes and plasma cells). Tissue cultures were negative. He was treated with unspecified corticosteroids. However, his lesions worsened, and the lesion count reached to 18, which were mostly located on the lower extremities and trunk. He was hospitalised for wound care and to optimize his treatment. At follow-up, he reported of consuming intranasal levamisole-adulterated cocaine weekly for 25 years. PG was thought to be related to levamisole. He was counselled to stop cocaine use, following which a significant improvement was observed. Eventually, he was started on infliximab treatment, following which a gradual re-epithelialisation and atrophic cribriform scars were observed. Case 2: The 46-year-old man was referred with 1 year history of generalised PG resistant to unspecified treatments. The diagnosis of PG was previously confirmed based on biopsy at an another centre. At current presentation, he had up to 22 cribriform ulcers and atrophic scars located on the trunk, with two lesions located in the preauricular region. He had been treated with prednisone and cyclosporine, but still presented with relapses. An investigation was unremarkable for an associated diseases. He was hospitalised. Despite immunosuppressive treatments, he continued to develop ulcers. His PG flares correlated with his discharges from hospital. Afterwards, he admitted of using levamisole-adulterated cocaine. His PG flare was thought to be related to continuous use of levamisole-adulterated cocaine. He was counselled regarding the cocaine use, and he was treated with prednisone and mycophenolate mofetil. At his last follow-up, a good improvement was noted [time to reactions onset not stated]. Lemieux A, et al. Multifocal cocaine-induced pyoderma gangrenosum: A report of two cases and review of literature. SAGE Open Medical Case Reports 8: 2020. Available 803501600 from: URL: http://doi.org/10.1177/2050313X20935736
0114-9954/20/1822-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 19 Sep 2020 No. 1822
Data Loading...
