Characteristic purpura of the ears, vasculitis, and neutropenia - A potential public health epidemic associated with levamisole-adulterated cocaine

Catherine Chung, Paul C. Tumeh, Ron Birnbaum, Belinda H. Tan, Linda Sharp, Erin McCoy, Mary Gail Mercurio, Noah Craft

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Dermatologists at the University of California, San Francisco recently reported two patients in the online Journal of the American Academy of Dermatology with purpura presumably induced by levamisole in contaminated cocaine. Levamisole-induced vasculitis and neutropenia has been reported elsewhere in the United States and Canada. Up to 70% of cocaine in the United States could be contaminated. Objective: We sought to describe similar cases of vasculitis associated with cocaine use. Methods: This is a retrospective case series. Results: We report 6 remarkably similar patients seen over just the past few months with retiform purpura on the body and tender purpuric eruptions, necrosis, and eschars of the ears after cocaine use in New York and California. All of these patients had positive perinuclear antineutrophil cytoplasmic antibody values and 3 of the 6 also had an associated neutropenia. Direct immunofluorescence studies suggested an immune complex-mediated vasculitis. Limitations: This case series is descriptive in nature and, because testing is not easily performed, we did not test for levamisole in the serum or blood to prove this is the causative agent. Conclusion: It appears the use of cocaine is associated with the peculiar clinical findings of ear purpura, retiform purpura of the trunk, and neutropenia. We believe this case series may represent the tip of the iceberg as a looming public health problem caused by levamisole. Although the direct causal relationship may be difficult to establish, the astute dermatologist or primary care physician should be able to recognize the characteristic skin lesions and should be wary of the potential development of agranulocytosis.

Original languageEnglish (US)
Pages (from-to)722-725.e2
JournalJournal of the American Academy of Dermatology
Volume65
Issue number4
DOIs
StatePublished - Oct 2011

Fingerprint

Levamisole
Purpura
Vasculitis
Neutropenia
Cocaine
Ear
Public Health
Direct Fluorescent Antibody Technique
Antineutrophil Cytoplasmic Antibodies
Agranulocytosis
San Francisco
Primary Care Physicians
Antigen-Antibody Complex
Canada
Necrosis
Skin
Serum

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Chung, Catherine ; Tumeh, Paul C. ; Birnbaum, Ron ; Tan, Belinda H. ; Sharp, Linda ; McCoy, Erin ; Mercurio, Mary Gail ; Craft, Noah. / Characteristic purpura of the ears, vasculitis, and neutropenia - A potential public health epidemic associated with levamisole-adulterated cocaine. In: Journal of the American Academy of Dermatology. 2011 ; Vol. 65, No. 4. pp. 722-725.e2.
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Characteristic purpura of the ears, vasculitis, and neutropenia - A potential public health epidemic associated with levamisole-adulterated cocaine. / Chung, Catherine; Tumeh, Paul C.; Birnbaum, Ron; Tan, Belinda H.; Sharp, Linda; McCoy, Erin; Mercurio, Mary Gail; Craft, Noah.

In: Journal of the American Academy of Dermatology, Vol. 65, No. 4, 10.2011, p. 722-725.e2.

Research output: Contribution to journalArticle

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AU - Chung, Catherine

AU - Tumeh, Paul C.

AU - Birnbaum, Ron

AU - Tan, Belinda H.

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