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Review
. 2018 Dec 11;8(6):339-344.
doi: 10.1080/20009666.2018.1536242. eCollection 2018.

Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis

Qiuyu Jin  1 , Sam Kant  2 , Jihad Alhariri  3 , Duvuru Geetha  4
Affiliations
Review

Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis

Qiuyu Jin et al. J Community Hosp Intern Med Perspect. .

Abstract

Levamisole is an antihelminth drug and a common cocaine contaminant, present in an estimated 71% of cocaine samples in the US. Levamisole-contaminated cocaine has been linked to an ANCA-associated vasculitis with cutaneous, renal, and pulmonary manifestations. We report the case of a 46 year old woman with known cocaine exposure who presents with recurrent, large purpuric and maculopapular rash of the extremities and face and review existing cases of levamisole/cocaine-associated ANCA vasculitis, We summarize the clinical presentation, treatment, and outcomes of levamisole induced vasculitis. There is emerging research on pathogenesis relating to neutrophil extracellular traps (NETs). We review studies implicating role of NETs in the pathogenesis of levamisole induced vasculitis. Further research to explore the use of NETs as therapeutic targets in drug induced vasculitis is needed.

Keywords: Anti-neutrophil cytoplasmic antibody; cocaine; levimasole.

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Figures

Figure 2.
Figure 2.
Purpura involving the ear.
Figure 3.
Figure 3.
Retiform purpura in the leg.
Figure 4.
Figure 4.
2X. Sections show a punch biopsy of skin. There is subepidermal edema with erythrocyte extravasation, Many superficial and deep dermal small vascular channels are surrounded by neutrophils and nuclear dust.
Figure 5.
Figure 5.
40X. Neutrophils and nuclear dust in the blood vessel walls causing destruction of the blood vessel walls.
Figure 1.
Figure 1.
Retiform purpura in the arms.
See this image and copyright information in PMC

References

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