Cocaine‐induced pyoderma gangrenosum‐like lesions

Pyoderma gangrenosum associated to the use of cocaine/levamisole. Series of three cases and literature review

“…PG associated with cocaine/levamisole is a recently described disease. Twenty-three cases published in the English-speaking literature were retrieved 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 9 , 11 ( Table 1 ), none of them in Colombia. Unlike the classic form, PG associated with cocaine is accompanied by vasculopathy and cutaneous or systemic vasculitis.…”

Multifocal cocaine-induced pyoderma gangrenosum: A report of two cases and review of literature

“…A recent review of 20 cases showed that 73% (11/15) of the cases were positive for p-ANCA and 43% (6/14) had at least one antiphospholipid antibody (APL), most frequently the anticardiolipin IgM. 11 Only two out of four were positive for levamisole; the search for levamisole is not often done nor positive considering its short half-life of 5.6 h. 7 It is therefore difficult to confirm its presence in cases of CIPG, but the serologic profiles of these two entities being similar raise the suspicion for its contribution in both cases. 15 Few other cases with negative ANCA and APL like our patients are also described.…”

“…15 Few other cases with negative ANCA and APL like our patients are also described. 8,11,14,16 Establishing a specific immunologic/serologic profile for CIPG is therefore challenging, but positive p-ANCA is still the most frequent finding.…”

“…5 The clinical presentation is often more widespread than the classic forms; lesions are multiple, bigger in diameter and mostly located on the trunk. 11 A cohort of eight patients, however, showed the lower extremities being the most frequent site of involvement, followed by the upper extremities and the trunk. 5 Both our cases highlight these differences with an average of 20 lesions with a diameter up to 15 cm.…”

“…Specific pre-auricular lesions are also described, just like our second case. 11,12 Head and neck lesions may also be a clue to the diagnosis as they represent less than 5% of the usual PG, 13 but have been reported in up to 75% of the CIPG. 5 The median interval between the cocaine consumption and the onset of symptoms is generally 1 week, ranging from 1-4 weeks.…”