Levamisole
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Cutaneous thrombotic vasculopathy in a cocaine user: case report A 52-year-old woman developed thrombotic vasculopathy after using cocaine which was suspected to contain levamisole [dosage not stated]. The woman, who had a history of vitiligo and hypothyroidism, presented with an acute-onset painful and pruritic region of dusky red erythema on her right ankle. The region progressed rapidly to include both her legs. She admitted to having snorted cocaine for the first time the previous night. She developed large blisters within the dusky area within a day. Some blisters burst and these contained clear fluid. She also had chest pain, cough, and fever. On examination, she was in extreme pain, febrile, and tearful. Skin examination showed violaceous plaques and flaccid bullae on both legs. There were also scattered plaques with few bullae on her left breast and left upper extremity. An x-ray revealed probable pneumonia. Laboratory investigations showed neutropenia and P-ANCA positivity. She also had elevated CRP, AST, ALT, and ALP levels. A urine test was positive for cocaine and also revealed proteinuria. A punch biopsy revealed thrombogenic vasculopathy with multiple microthrombi. The woman was treated with antibiotics, analgesics, and skin emollients. Her liver enzymes and WBC count normalised. She was discharged with skin care instructions and advised to abstain from cocaine. Ten days later, the woman was readmitted with new lesions. These were similar to her previous ones. Furthermore, her old lesions had worsening necrotic ulcers. She admitted to having used cocaine the previous night and the lesions had developed within a day. Surgical debridement of her necrotic ulcers was performed. Author comment: "We have a strong reason to believe that exposure to cocaine led to the cutaneous thrombogenic vasculopathy in our patient. . . Furthermore, we think that the lesions were caused by levamisole in particular." John S, et al. Cocaine-induced thrombotic vasculopathy. American Journal of the 803068538 Medical Sciences 342: 524-6, No. 6, Dec 2011 - USA
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Reactions 31 Mar 2012 No. 1395
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