• Korey Ullrich, Robert Koval, Erin Koval, Srinivas Bapoje, and Joel M Hirsh.
• Division of Rheumatology, Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
• J Clin Rheumatol. 2011 Jun 1;17(4):193-6.

AbstractFive patients with an antineutrophil cytoplasmic antibody (ANCA)-associated cutaneous vasculopathy secondary to levamisole-adulterated cocaine were prospectively followed up at a single hospital. All patients presented with retiform purpura, with ear involvement being the most characteristic finding. Cocaine metabolites were present on urine toxicology screening, with 2 of 4 of those tested also being positive for levamisole. High-titer polyspecific ANCA and positive antiphospholipid antibody tests were defining laboratory features. Thrombosis and/or leukocytoclastic vasculitis were seen on skin biopsy. Improvement of skin lesions and laboratory findings occurred with cessation of cocaine; however, arthralgias and other complications developed. Levamisole-adulterated cocaine is a cause of a cutaneous vasculopathy associated with characteristic laboratory and clinical features that allow it to be distinguished from classic ANCA-associated small-vessel vasculitides. The chronic sequelae of this syndrome and the potential role for immunosuppression are yet to be completely defined.

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