TY  - CHAP
M1  - Book, Section
TI  - Levamisole-Associated Purpura
A1  - Yazdany, Jinoos
A1  - Manno, Rebecca
A1  - Hellmann, David B.
A1  - Imboden Jr., John B.
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
PY  - 2021
T2  - Current Medical Diagnosis & Treatment 2021
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.  Biopsies  reveal  widespread  thrombosis  of  small  cutaneous  vessels  with  varying  degrees  of  vasculitis.  The  syndrome  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).  There  is  no  consensus  on  treatment  of  levamisole-induced  purpura,  but  early  lesions  can  resolve  with  abstinence.  Use  of  levamisole-adulterated  cocaine  also  has  been  linked  to  neutropenia,  agranulocytosis,  and  pauci-immune  glomerulonephritis.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2020/10/24
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1175803591
ER  -