Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients.
Background: Recently, isolated reports of pyoderma gangrenosum (PG) secondary to levamisole-contaminated cocaine have been described, with similar serologic findings to the vasculopathic presentation.Objective: We sought to describe clinical, histopathological, and serologic findings in 8 patients w...
| Published in: | Journal of the American Academy of Dermatology Vol. 74; no. 5; pp. 892 - 899 |
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| Main Authors: | , , , , |
| Format: | research Journal Article |
| Published: |
Elsevier B.V.
May2016
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114522793&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 114522793 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01909622 1ZF jtl: Journal of the American Academy of Dermatology issn: 01909622 maglogo: N pubinfo: dt: May2016 vid: 74 iid: 5 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 114522793 114522793 NLM26785804 114522793 10.1016/j.jaad.2015.11.040 NLM26785804 114522793 ppf: 892 ppct: 7 formats: tig: atl: Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients. aug: au: Jeong, Haneol S. Layher, Heather Cao, Lauren Vandergriff, Travis Dominguez, Arturo R. affil: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas sug: subj: Cocaine Adverse Effects Pyoderma Gangrenosum Pathology Pyoderma Gangrenosum Chemically Induced Drug Contamination Imidazoles Adverse Effects Pyoderma Gangrenosum Drug Therapy Prognosis Treatment Outcomes Risk Assessment Adrenal Cortex Hormones Therapeutic Use Severity of Illness Indices Adult Biopsy, Needle Middle Age Aged Female Immunohistochemistry Retrospective Design Male Prospective Studies Human Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Female Male ab: Background: Recently, isolated reports of pyoderma gangrenosum (PG) secondary to levamisole-contaminated cocaine have been described, with similar serologic findings to the vasculopathic presentation.Objective: We sought to describe clinical, histopathological, and serologic findings in 8 patients with PG associated with levamisole-contaminated cocaine.Methods: Eight consecutive patients presenting with this disease spanning the period from 2011 to 2015 were included for the cohort. Observed variables included: lesion distribution, morphology, serologic titers, and histopathologic evaluation for vasculitis and vasculopathy.Results: All patients reported cocaine exposure prior to the onset of lesions resembling PG. Lesions appeared primarily on the upper (6 of 8 patients) and lower (all 8 patients) extremities. Most patients demonstrated elevated titers for p-ANCA and antiphospholipid antibodies, and a diffuse dermal infiltrate dominated by neutrophils was seen in all biopsy specimens. Lesions improved or remained stable with conservative management or short courses of steroids, and recurrence was only noted on re-exposure to adulterated cocaine.Limitations: The study is limited by sample size.Conclusions: PG may occur after exposure to levamisole-adulterated cocaine. Clinical and histopathological findings resemble those seen in conventional forms of PG, whereas serologic findings mirror those seen in other levamisole-associated vasculopathic or vasculitic eruptions. Cocaine avoidance represents a cornerstone of management in these patients. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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