TY  - CHAP
M1  - Book, Section
TI  - Levamisole-Associated Purpura
A1  - Manno, Rebecca L.
A1  - Yazdany, Jinoos
A1  - Tarrant, Teresa K.
A1  - Kwan, Mildred
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
A2  - McQuaid, Kenneth R.
Y1  - 2023
N1  - 
T2  - Current Medical Diagnosis & Treatment 2023
AB  - Exposure  to  levamisole,  a  prevalent  adulterant  of  illicit  cocaine  in  North  America,  can  induce  a  distinctive  clinical  syndrome  of  retiform  purpura  and  cutaneous  necrosis  affecting  the  extremities,  ears,  and  skin  overlying  the  zygomatic  arch.  The  syndrome  has  been  linked  to  neutropenia,  agranulocytosis,  and  pauci-immune  glomerulonephritis.  It  is  associated  with  the  lupus  anticoagulant,  IgM  antibodies  to  cardiolipin,  and  very  high  titers  of  p-ANCAs  (due  to  autoantibodies  to  elastase,  lactoferrin,  cathepsin-G,  and  other  neutrophil  components  rather  than  to  myeloperoxidase  alone).  Biopsies  reveal  widespread  thrombosis  of  small  cutaneous  vessels  with  varying  degrees  of  vasculitis.  There  is  no  consensus  on  treatment  of  levamisole-induced  purpura,  but  early  lesions  can  resolve  with  abstinence.  There  may  be  long-term  sequelae  of  levamisole  exposure,  such  as  deforming  cutaneous  lesions,  arthralgias,  and  arthritis.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1193125843
ER  -