In order to describe the clinical and serologic features of a cutaneous vasculitis due to cocaine contaminated with the adulterant levamisole, we report four new cases of this syndrome along with 12 previously reported cases identified through a PubMed Literature search (1964 to March 2011). Of the 16 patients described, the average age was 43, with a female predominance (81% of patients). Over half of patients had involvement of the earlobes, and the rash frequently affected the extremities in a "retiform" pattern. Leukopenia or neutropenia was reported in 56% of patients. Ninety-three percent were anti-neutrophil cytoplasmic antibody positive, and 63% tested positive for anti-phospholipid antibodies. The predominant pattern seen on histopathological examination of the skin was small vessel vasculitis and/or a thrombotic vasculopathy. Treatment in these patients varied widely, with several patients showing improvement or resolution of the rash without specific therapy following cessation of illicit drug use. This new cutaneous vasculitis syndrome can be recognized by its characteristic rash and skin pathology, together with leukopenia and autoantibody production. Certain clinical features can be attributed to the adulterant levamisole, though cocaine as well may play a role in its pathogenesis.

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Upper extremity stress fractures, which are relatively rare, have become increasingly common, with olecranon stress injuries representing a subset primarily affecting throwing athletes. Olecranon stress fractures have been classified to fit specific radiographic patterns, with most of these injuries typified by a fracture line. Only a handful of olecranon stress injury cases report magnetic resonance imaging findings of osseous edema within the olecranon, as in our case of a 17-year-old competitive overhand baseball pitcher with elbow pain. The patient was treated conservatively and had resolution of pain after 6 weeks of rest, followed by a 6-week throwing progression with full return to pitching.