Painful Retiform Purpura with Cutaneous Necrosis

Main Article Content

Alfredo Siller Jr.
Center for Clinical Studies, Webster, TX, USA

Joseph Jebain
Center for Clinical Studies, Webster, TX, USA

Yomna Amer
University of Louisville School of Medicine

Christopher T. Haley
Department of Dermatology, Baylor Scott & White Medical Center, Temple, TX, USA

Leon Chen
Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA

Stephen K. Tyring
Department of Dermatology, University of Texas Health Science Center at Houston, Houston, TX, USA

Keywords

Vasculitis, Levimasole, Autoimmune, Necrosis

Abstract

Levamisole-induced vasculitis is characterized by a painful, purpuric rash in a retiform or stellate pattern with or without central necrosis that commonly involves the trunk, extremities, digits, distal nose, cheeks, and ear helices. This clinical syndrome is associated with the use of levamisole-adultered cocaine. Histologic findings for levamisole-induced vasculitis are not disease specific but may include leukocytoclastic vasculitis, microvascular thrombosis, and panniculitis. Laboratory findings of levamisole-induced toxicity include agranulocytosis, neutropenia, hepatotoxicity, glomerulonephritis, pulmonary hemorrhage, and positive p-ANCA, c-ANCA tests, ANA, or lupus anticoagulant. The differential diagnosis for levamisole-induced vasculitis includes leukocytoclastic vasculitis, drug reaction, cryoglobulinemia, idiopathic thrombocytopenic purpura, granulomatosis with polyangiitis, Churg-Strauss syndrome, and polyarteritis nodosa. Levamisole-induced vasculitis typically resolves spontaneously with cessation of cocaine use however; recurrence is common following re-exposure.

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Published
Oct 27, 2020
DOI https://doi.org/10.25251/skin.4.6.18

Article Details

How to Cite
Siller Jr., A., Jebain, J., Amer, Y., Haley, C. T., Chen, L., & Tyring, S. K. (2020). Painful Retiform Purpura with Cutaneous Necrosis. SKIN The Journal of Cutaneous Medicine, 4(6), 595–598. https://doi.org/10.25251/skin.4.6.18
Issue
Vol. 4 No. 6 (2020): November Issue & Poster Presentations (FC20 Dermatology Conference®)
Section
Brief Articles
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