ABSTRACT
Levamisole has been increasingly used as an adulterant of cocaine in recent years, emerging as a public health challenge worldwide. Levamisole-associated toxicity manifests clinically as a systemic vasculitis, consisting of cutaneous, hematological, and renal lesions, among others. Purpura retiform, cutaneous necrosis, intravascular thrombosis, neutropenia, and less commonly crescentic nephritis have been described in association with anti-neutrophil cytoplasmic antibodies (ANCAs) and other autoantibodies. Here we report the case of a 49-year-old male who was a chronic cocaine user, and who presented spontaneous weight loss, arthralgia, and 3 weeks before admission purpuric skin lesions in the earlobes and in the anterior thighs. His laboratory tests on admission showed serum creatinine of 4.56 mg/dL, white blood count 3,800/μL, hemoglobin 7.3 g/dL, urinalysis with 51 white blood cells/μL and 960 red blood cells/μL, and urine protein-to-creatinine ratio 1.20. Serum ANCA testing was positive (>1:320), as well as serum anti-myeloperoxidase and anti-proteinase 3 antibodies. Urine toxicology screen was positive for cocaine and levamisole, with 62.8% of cocaine, 32.2% of levamisole, and 5% of an unidentified substance. Skin and renal biopsies were diagnostic for leukocytoclastic vasculitis and pauci-immune crescentic glomerulonephritis, respectively. The patient showed a good clinical response to cocaine abstinence, and use of corticosteroids and intravenous cyclophosphamide. Last serum creatinine was 1.97 mg/dL, white blood cell count 7,420/μL, and hemoglobin level 10.8 g/dL. In levamisole-induced systemic vasculitis, the early institution of cocaine abstinence, concomitant with the use of immunosuppressive drugs in severe cases, may prevent permanent end organ damage and associate with better clinical outcomes.
Subject(s)
Humans , Male , Middle Aged , Purpura/chemically induced , Levamisole/adverse effects , Cocaine/adverse effects , Systemic Vasculitis/chemically induced , Glomerulonephritis/chemically induced , Purpura/pathology , Systemic Vasculitis/pathology , Glomerulonephritis/pathologyABSTRACT
Etofenamate is a non-steroidal anti-inflammatory drug (NSAID). Clinical findings caused by etofenamate are uncommon. Allergic contact dermatitis is the most common cutaneous reaction reported. But petechial eruption due to etofenamate had not been reported yet. This report concerns an 11-year old male with petechial eruption after application of topical etofenamate. Physicians need to be aware that patients can develop an asymptomatic purpuric eruption when etofenamate is ordered.
El etofenamato es un antiinflamatorio no esteroideo (AINE). Los hallazgos clínicos sobre los efectos del etofenamato son poco comunes. La dermatitis alérgica por contacto es la reacción cutánea más comúnmente reportada. En cambio, la erupción petequial a causa del etofenamato no se había reportado hasta ahora. Este reporte trata de un varón de 11 años de edad con erupción petequial tras la aplicación del etofenamato tópico. Es necesario que los médicos tomen conciencia de que los pacientes pueden desarrollar una erupción púrpura asintomática, a la hora de prescribir el etofenamato.
Subject(s)
Child , Humans , Male , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Flufenamic Acid/analogs & derivatives , Purpura/chemically induced , Administration, Cutaneous , Flufenamic Acid/adverse effectsABSTRACT
Corticosteroids, though known to act effectively against allergy and hypersensitivity, may themselves produce such reactions, ranging from urticaria to anaphylaxis. A middle-aged man with collagen vascular disease developed purpuric rash on repeated administration of steroids. This acute purpuric reaction with sequential colour changes is different than the more common senile purpura-like lesions induced by intake of steroids. It is also different than the purpuric lesions associated with collagen vascular disease per se. The present case favours an allergic aetiology.
Subject(s)
Adult , Connective Tissue Diseases/drug therapy , Drug Eruptions/etiology , Humans , Male , Prednisolone/administration & dosage , Purpura/chemically inducedABSTRACT
Presentamos el primer caso de necrosis cumarínica de la bibliografía nacional. Se trata de una paciente obesa anticoagulada por tromboembolismo pulmonar. Suele comenzar entre los 3 y 10 días de iniciada la terapéutica cumarínica, pero en ocasiones dicho lapso puede ser mayor, como en nuestro caso que fue de 5 años. El cuadro clínico es típico: púrpura necrótica ampollar, encontrándose necrosis epidérmica y trombos fibrinosos sin vasculitis, en el estudio biópsico. Podría deberse a una acción de los cumarínicos sobre el factor VII, tal vez por déficit hereditario de la proteína "C". Esto no lo pudimos corroborar en nuestra paciente