Pyoderma gangrenosum associated with levamisole-adulterated cocaine in a c-ANCA positive patient

Gadarowski, Mary Beth; Agnihothri, Ritesh; Scott, Glynis; Plovanich, Molly

doi:10.5070/d3271052034

Cited by 4 publications

(4 citation statements)

References 12 publications

(28 reference statements)

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“…In the remaining 20 cases, adulterants were only hypothesized based on the observed symptoms, disease or indirect sequelae or confiscated drug analysis. Suspected substances were levamisole ( n = 10), methaqualone and several benzodiazepines, caffeine and acetaminophen ( n = 1), 5F-MDMB- PINACA ( n = 7) and phenethylamine ( n = 1), asbestos ( n = 1) [ 33 , 42 , 44 , 45 , 46 , 47 , 52 , 53 , 54 , 55 , 56 ]. Considering all of the reported cases, levamisole was the most prevalent adulterating agent in street cocaine ( n = 17 cases) [ 33 , 42 , 44 , 45 , 46 , 47 , 54 , 57 , 58 , 59 , 60 , 61 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…Generally, ANCA positivity is a marker of autoimmune pathologies including systemic autoimmune vasculitis, necrotising crescentic glomerulonephritis, inflammatory bowel disease and other autoimmune pathologies [ 63 ]. In levamisole-adulterated cocaine intoxications [ 33 , 44 , 45 , 46 , 47 , 54 , 57 , 58 , 59 , 60 , 61 , 62 ] the p- or c-ANCA positivity was associated with Cocaine Induced Midline Destructive Lesions (CIMDL) ( n = 5) [ 44 , 57 ], vasculitis ( n = 8) [ 33 , 47 , 58 , 59 , 60 , 61 ], membranous glomerulonephritis ( n = 4) [ 58 , 62 ], pyoderma gangrenosum ( n = 1) [ 54 ], neutropenia complicated with bowel necrosis ( n = 1) [ 46 ], and cerebral white matter dysfunction ( n = 1) [ 45 ]. These autoimmune pathologies were more frequent in women (100% ANCA positivity) than men (90% of ANCA positivity) [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

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Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Trana

Berardinelli

Montanari

et al. 2022

IJMS

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Adulteration is a well-known practice of drug manufacturers at different stages of drug production. The intentional addition of active ingredients to adulterate the primary drug may enhance or mask pharmacological effects or may produce more potent drugs to increase the number of available doses and the dealer’s profit. Adulterants found in different drugs change over time in response to different factors. A systematic literature search in PubMed and Scopus databases and official international organizations’ websites according to PRISMA guidelines was performed. A total of 724 studies were initially screened, with 145 articles from PubMed and 462 from Scopus excluded according to the criteria described in the method section. The remaining 117 records were further assessed for eligibility to exclude articles without sufficient data. Finally, 79 studies were classified as “non-biological” (n = 35) or “biological” (n = 35 case reports; n = 9 case series) according to the samples investigated. Although the seized samples analyses revealed the presence of well-established adulterants such as levamisole for cocaine or paracetamol/acetaminophen for heroin, the reported data disclosed new adulteration practices, such as the use of NPS as cutting agents for classic drugs of abuse and other NPS. For example, heroin adulterated with synthetic cannabinoids or cocaine adulterated with fentanyl/fentalogues raised particular concern. Notably, adulterants play a role in some adverse effects commonly associated with the primary drug, such as levamisole-adulterated cocaine that may induce vasculitis via an autoimmune process. It is essential to constantly monitor adulterants due to their changing availability that may threaten drug consumers’ health.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Trana

Berardinelli

Montanari

et al. 2022

IJMS

View full text Add to dashboard Cite

show abstract

“…Levamisole‐tainted cocaine can also create purpuric lesions and generate a mixed pattern of ANCA, including PR3‐ANCA and MPO‐ANCA 20,21 . Recent reports discuss pyoderma gangrenosum lesions on the extremities or truncal area in this setting in the absence of clinically apparent purpura 22 . Diagnosis can be quite challenging.…”

Section: Granulomatosis With Polyangiitis (Gpa)mentioning

confidence: 99%

“…20,21 Recent reports discuss pyoderma gangrenosum lesions on the extremities or truncal area in this setting in the absence of clinically apparent purpura. 22 Diagnosis can be quite challenging. In these cases, extreme care must be taken to undertake full skin, oral, ear, nose, and throat examination, correlated with histopathology, laboratory findings, and key elements of history in order to make the correct diagnosis.…”

Section: Granulomatosis With Polyangiitis (Gpa)mentioning

confidence: 99%

Cutaneous manifestations of antineutrophil cytoplasmic antibody‐associated vasculitis (AAV): a concise review with emphasis on clinical and histopathologic correlation

Gibson

2022

Int J Dermatology

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a group of small vessel vasculitides grouped by commonalities of clinical manifestations and ANCA testing. Skin findings are not uncommon, although there is considerable overlap and many times nonspecificity. In general, patients with skin findings tend to have more significant systemic illness, and skin lesions most often develop simultaneously or following onset of systemic symptoms. There are clinical and pathological clues of help in the differentiation of skin findings in these disorders. Purpura of various forms with leukocytoclastic vasculitis is common to all AAV. Granulomatosis with polyangiitis (GPA) comprises the largest number of patients with an AAV. Upper airway, oral, ear, and facial lesions, with or without granuloma, are more commonly seen in this AAV. Pyoderma gangrenosum-like lesions, including facial location, while not common are most closely associated with GPA.Eosinophilic granulomatosis with polyangiitis (EGPA) as its name implies is more closely associated with eosinophilic, allergic, or asthmatic conditions. Papular lesions of the extensor extremities showing extravascular granulomatous changes are characteristic but not specific for EGPA. Microscopic polyangiitis (MPA) is more closely associated with livedoid skin changes, and vascular inflammation tends to be deeper in the skin than with the other AAV. Extravascular granulomas are not expected. While the skin findings in AAV can be nonspecific and overlapping, combining careful full skin examination with histopathologic study of selected lesions is critical to making the correct diagnosis and in ruling out other similar diseases not ANCA related. The aim of this article is to encourage increased participation by dermatologists and dermatopathologists in the care of these patients.

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Antihelminthic drugs

Onakpoya

2022

Side Effects of Drugs Annual

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Pyoderma gangrenosum associated with levamisole-adulterated cocaine in a c-ANCA positive patient

Cited by 4 publications

References 12 publications

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Cutaneous manifestations of antineutrophil cytoplasmic antibody‐associated vasculitis (AAV): a concise review with emphasis on clinical and histopathologic correlation

Antihelminthic drugs

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