DISEASES
description
Cocaine-related necrotizing vasculopathy. A possible complication of cocaine use is necrotizing vasculitis; Two distinct vasculitis syndromes have been described due to cocaine. One is a cocaine-related midline destructive lesion, secondary to a direct vasoconstrictor effect of cocaine, inducing ischemic necrosis of the nasal septal cartilage and perforation of the septum, mimicking findings of granulomatosis with polyangiitis in the upper airways. The other is ANCA-associated vasculitis, attributed to the drug Levamisole that is often used to ‘cut’ both powder and crack cocaine (Levamisole is found in about 70% of street cocaine). The main manifestations are typical cutaneous findings, arthralgia, otolaryngologic involvement, and agranulocytosis. A high degree of suspicion and awareness is needed in order to properly diagnose and treat these patients. ANCA myeloperoxidase (MPO) and/or proteinase 3 (PR3) may be positive but a more specific biomarker is the finding of antibodies to elastase.
Symptoms
- Painful rash usually on extremities, cheeks, nose, and earlobes
- Rarely reported fever, weight loss, alopecia, dry eyes, oral ulcers, photosensitivity, or arthralgia
- Tender purpuric eruptions with central necrosis
- Acute onset of dark lesions