Pyoderma gangrenosum and Wegener granulomatosis-like syndrome induced by cocaine

Jiménez‐Gallo, David; Albarrán-Planelles, C.; Linares‐Barrios, Mario; Rodríguez-Hernández, Carmen; Martínez-Rodríguez, A.; García-Moreno, E.; Bravo-Monge, R.

doi:10.1111/ced.12207

Cited by 27 publications

(25 citation statements)

References 10 publications

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“…Cocaine is also associated with vasculitides, such as urticarial vasculitis [53], retiform purpura [54], scleroderma [32,55], Raynaud's phenomenon [56], Churg-Strauss [57], and a P-ANCA positive Wegener granulomatosis-like syndrome [58,59]. P-ANCA specifically against human neutrophil elastase distinguishes cocaine-induced dermatologic and rheumatologic diseases from primary autoimmune diseases [59].…”

Section: Cocainementioning

confidence: 99%

Dermatologic Signs and Symptoms of Substance Abuse

Raiker¹,

Aouthmany²

2016

J Clin Exp Dermatol Res

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Various substances of abuse are known to cause specific cutaneous manifestations. In this review, we highlight the cutaneous manifestations associated with the use of cocaine, heroin, marijuana, methamphetamine, alcohol, and anabolic steroids. Cutaneous signs of tanning addiction are also discussed, as tanning bed use is a particularly relevant and growing problem in Dermatology. We also provide examples of general signs of drug abuse, including stigmata of injection drug use, vascular complications, and infectious complications. This review aims to make clinicians more aware of these signs in order to better recognize substance abuse disorders and guide effective treatment.

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Section: Cocainementioning

confidence: 99%

Dermatologic Signs and Symptoms of Substance Abuse

Raiker¹,

Aouthmany²

2016

J Clin Exp Dermatol Res

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“…[39][40][41][42][43] Short-term cocaine use can lead to mucosal ulceration and necrosis. Long-term use has been associated with ischemia of not only the mucosal tissue but cartilage and bone, resulting in midline deformity and septal/palatal perforations.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

“…Long-term use has been associated with ischemia of not only the mucosal tissue but cartilage and bone, resulting in midline deformity and septal/palatal perforations. [39][40][41][42][43] Histologically, one can see significant granulomatous inflammation, infarction, necrosis, and giant cell reaction (Figure 4, A through C). Necrotizing vasculitis may be evident.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

“…As a result, CIMDL shows clinical and histopathologic overlap with other midline destructive lesions, particularly GPA. [39][40][41][42][43] Interestingly, CIMDL can be associated with the presence of ANCA, making distinction from overlapping vasculitic syndromes difficult. The etiology of CIMDL is not clear.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

“…The ANCA in CIMDL is often perinuclear ANCA and targets human neutrophil elastase, but patients can also have c-ANCA targeting P3, and therefore the distinction from GPA can be difficult. [39][40][41][42][43] The pathogenesis of cocaine in the development of CIMDL likely involves vasoconstriction resulting in ischemia and resulting mucosal and bone/cartilage necrosis, but recent evidence also implicates the possibility of levamisole (which is a known contaminant in cocaine) playing a role in CIMDL. 43 It is believed that levamisole induces the autoimmune reaction because this agent has been associated with necrotizing vasculitis in other areas of the body.…”

Section: Cocaine-induced Midline Destructive Lesionsmentioning

confidence: 99%

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Differential Diagnosis of Necrotizing Sinonasal Lesions

Montone

2015

Archives of Pathology &Amp; Laboratory Medicine

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Context A number of entities may result in necrosis in the sinonasal tract and lead to significant morbidity and mortality. These include infections, necrotizing vasculitis, neoplastic processes, and drug dependency. This review will concentrate on the differential diagnosis of sinonasal necrotizing lesions. Objective To review the differential diagnoses of necrotizing destructive lesions of the sinonasal tract. Data Sources The current literature was reviewed to provide updated information regarding the differential diagnosis of sinonasal necrotizing lesions, including infectious disease processes; antineutrophilic cytoplasmic antibody–associated vasculitides; neoplastic processes, particularly natural killer/T-cell lymphomas; and drug abuse. Conclusions The differential diagnosis of necrotizing sinonasal lesions is broad, with often overlapping diagnostic features that lead to diagnostic challenges. Ancillary tests such as special stains and immunohistochemical studies can offer significant assistance.

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Retrospective Case Series of Cocaine-Associated Plasma Cell Orificial Mucositis

Viedma-Martinez,

Gallo-Pineda,

Recio-Monescillo

et al. 2024

JAMA Dermatol

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ImportancePlasma cell orificial mucositis (PCOM) associated with cocaine use is an emerging, rare condition that has become a concern in Spain in recent years. Limited knowledge exists regarding this novel condition.ObjectivesTo delineate the clinicopathologic characteristics of this emerging entity and establish a novel approach in the differential diagnosis of cocaine-associated lesions.Design, Setting, and ParticipantsA descriptive, retrospective, multicenter case series of 10 patients diagnosed with cocaine-associated PCOM was conducted in Spain from April 2020 to March 2023.Main Outcomes and MeasuresPatient demographic, clinical, histopathologic, and treatment data were collected.ResultsA total of 10 patients (6 [60%] male; median [range] age, 45.5 [36-66] years) presenting with exudative ulcerated plaques were identified for this study. The lesions had raised and erythematous edges over the nostril and a median (range) evolution time of 9 (2-24) months. Septal or palate perforations were observed in 4 (40%) of the patients. Biopsies revealed a dense inflammatory infiltrate of plasma cells in the dermis without atypia and with eosinophils. All patients reported recent cocaine use. Three urine tests detected cocaine but found no presence of amphetamines or opiates. Six patients improved with corticosteroid therapy. Up to 60% of patients were lost to follow-up.Conclusions and RelevanceThis case series describes the clinicopathologic characteristics of PCOM, an emerging entity associated with cocaine use in Spain, and demonstrates a novel approach in the differential diagnosis of cocaine-associated lesions. To date, cocaine-associated skin lesions have been reported as neutrophilic dermatoses and vasculitis. The appearance of a plasma cell infiltrate changes what has been described in the medical literature so far. PCOM is a benign condition of unknown cause characterized by a proliferative polyclonal plasma cell infiltrate. A comprehensive differential diagnosis workup is required to reach this exclusionary diagnosis. Several irritants have been documented in cases of PCOM, and a hypersensitivity mechanism has been proposed. Since the initial report of cocaine-associated PCOM in Spain, its incidence has experienced a surge in the country. The cause of this phenomenon may be attributed to newly unidentified adulterants. The administration of corticosteroids and discontinuation of cocaine use are the sole treatments that have demonstrated efficacy. Clinicians should be vigilant regarding this emerging condition and conduct inquiries into cocaine use. Additional research is required to clarify the pathophysiology of this emerging condition.

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Pyoderma gangrenosum and Wegener granulomatosis-like syndrome induced by cocaine

Cited by 27 publications

References 10 publications

Dermatologic Signs and Symptoms of Substance Abuse

Dermatologic Signs and Symptoms of Substance Abuse

Differential Diagnosis of Necrotizing Sinonasal Lesions

Retrospective Case Series of Cocaine-Associated Plasma Cell Orificial Mucositis

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