RT Book, Section
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.
SR Print(0)
ID 1193125843
T1 Levamisole-Associated Purpura
T2 Current Medical Diagnosis & Treatment 2023
YR 2023
FD 2023
PB McGraw-Hill Education
PP New York, NY
SN 9781264687343
LK accessmedicine.mhmedical.com/content.aspx?aid=1193125843
RD 2024/04/16
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.