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VOLUME 4 , ISSUE 1 ( Vol. 4, 2016 ) > List of Articles

CASE REPORT

Cocaine-Induced Intermittent Purpuric Lesions of the Ear Auricle: An Increasing Entity

Villarreal IM., Ibáñez A., Martin J., Pinilla M, García-Berrocal JR.

Keywords : Ear auricle, Cocaine, Levamisole, Purpura, vasculopathy

Citation Information : IM. V, A. I, J. M, M P, JR. G. Cocaine-Induced Intermittent Purpuric Lesions of the Ear Auricle: An Increasing Entity. Arch Craniofac Sci 2016; 4 (1):1-3.

DOI: 10.5005/ACOFS-11029-04101

License: CC BY-NC 4.0

Published Online: 28-02-2016

Copyright Statement:  Copyright © 2016; BPH.


Abstract

Introduction: A new challenge to the medical community is presented with Levamisole, an antihelmintic immunomodulatory agent, recently used in combination with cocaine to enhance its psychoactive effects. The prevalence of cocaine induced vasculopathy is increasing and physicians need to be aware of this emerging condition due to its serious possible complications. Methods: We report a case of a 52 year old man with intermittent purpuric skin lesions located in the auricles in a patient with regular cocaine consumption. Histopathology of a punch biopsy, revealed diffuse presence of thrombi in the superficial and deep dermal blood vessels with a neutrophilic perivascular infiltrate with leukocytoclasia. Results: There are several clinical and laboratory findings that support a diagnosis of Levamisole induced vasculitis, including ANCA positivity, specific anti-HNE antibodies and auricle involvement, that help distinguish this condition from autoimmune vasculitis and all of the results were negative. Conclusion: A high index of suspicion should be kept in mind if this is considered a potential cause for purpuric intermittent lesions in cocaine abusers. To aid the diagnosis a punch biopsy associated with an extensive workup including immunologic testing is recommended. Regardless, no optimal treatment has been described, steroids have been used preventing progressive damage but complete withdrawal is indispensable


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