Autoimmune syndrome associated with cocaine and levamisole

Authors

  • María Eugenia Amoreo San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina
  • Virginia Dimotta San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina
  • Hernán Feola San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina
  • María Victoria Pérez Klala San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina
  • María Alejandra Verea San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

DOI:

https://doi.org/10.47196/da.v30i3.2684

Keywords:

cocaine/levamisole, vasculitis, ANCA, pyoderma gangrenosum

Abstract

Cocaine consumption in Argentina is very prevalent and leads to wide spectrum of toxic complications depending on its concentration and adulterants, increasingly reported in the literature since 2010. We present the case of a patient with lesions corresponding to ANCA-associated vasculitis (AAV) and pyoderma gangrenosum (PG) at different occasions, reflecting the variability in the cutaneous manifestations of the cocaine/levamisole-associated autoinmune síndrome (CLAAS).

Author Biographies

María Eugenia Amoreo, San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

Resident Physician, Dermatology Service

Virginia Dimotta, San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

Resident Physician, Dermatology Service

Hernán Feola, San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

Dermatologist, Dermatology Service

María Victoria Pérez Klala, San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

Dermatologist, Dermatology Service

María Alejandra Verea, San Juan de Dios Interzonal Specialized Hospital for Acute and Chronic Patients, La Plata, Province of Buenos Aires, Argentina

Head of the Dermatology Service

References

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II. Sánchez-Puigdollers A, Just-Sarobé M, Pastor-Jané L. Cuadros cutáneo-mucosos asociados al consumo de cocaína. Actas Dermosifiliogr. 2023;114:125-131.

III. Bradford M, Rosenberg B, Moreno J, Dumyati G. Bilateral necrosis of earlobes and cheeks: another complication of cocaine contaminated with levamisole. Ann Intern Med. 2010;152:758-759.

IV. Martínez-Gómez M, Ramírez-Ospina JA, Ruiz-Restrepo JD, Velásquez-Lopera MM. Pyoderma gangrenosum associated to the use of cocaine/levamisole. Series of three cases and literature review. An Bras Dermatol. 2021;96:188-195.

V. Lemieux A, Ran Cai Z, Belisle A, Chartier S, et ál. Multifocal cocaine-induced pyoderma gangrenosum. A report of two cases and review of literature. SAGE Open Med Case Rep. 2020;8:1-5.

VI. Jeong HS, Layher H, Cao L, Vandergriff T, et ál. Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine. Clinical, serologic, and histopathologic findings in a cohort of patients. J Am Acad Dermatol. 2016;74:892-898.

VII. Alexander SA, Mathew Thomas V, Savage JA. Elevated C-reactive protein and role of steroids in cocaine associated levamisole induced vasculitis. Cureus. 2020;12:e7597.

VIII. Urosevic-Maiwald M, Hardenberg JHB, Hafner J, Brüggen MC. Cocaine/levamisole induced, skin limited ANCA associated vasculitis with pyoderma gangrenosum like presentation. Dermatopathology (Basel). 2022;9:207-211.

IX. Cevallos-Abad MI, Córdoba-Iturriagagoitia A, Larrea-García M. Síndrome autoinmune cocaína-levamisol. Presentación de un caso. Actas Dermosifiliogr. 2021;112:772-774.

X. Cascio MJ, Jen KY. Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity. Curr Opin Hematol. 2018;25:29-36.

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Published

2024-10-21

Issue

Vol. 30 No. 3 (2024): September-December

Section

Clinical Cases

License

Copyright (c) 2024 on behalf of the authors. Reproduction rights: Argentine Society of Dermatology

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