ABSTRACT
Diffuse purpura is an uncommon skin manifestation found in platelet and coagulation disorders, meningococcemia, vasculitides and cocaine use. Reports of cocaine-related purpura predominantly involve adulteration with the anti-helminthic, levamisole. Levamisole enhances the effects of cocaine and is known to cause vasculitis. Recently, the CDC also released an advisory of oxymorphone being used intravenously causing thrombogenic thrombocytopenic purpura (TTP). We report the case of a patient with diffuse purpura ultimately diagnosed with cocaine-related thrombogenic vasculopathy. In the current environment of adulterated cocaine usage and increased prescription narcotic abuse, it is crucial to investigate substance abuse as a cause of diffuse purpura.
ABSTRACT
OBJECTIVES: To identify a 50.8-kDa biomarker to perform a preliminary clinical evaluation of its utility as an aid in the early detection of prostate cancer. METHODS: The 50.8-kDa protein, previously called NMP48, was partially purified from the serum of an individual with prostate cancer and identified by peptide mass fingerprinting of tryptic peptides from an in-gel digest. Serum samples were obtained from men with biopsy-confirmed prostate cancer, high-grade prostatic intraepithelial neoplasia, and benign histologic features, from men with clinically defined benign prostatic hyperplasia, and from controls without prostatic disease. These samples were analyzed for the presence of the biomarker by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. RESULTS: The 50.8-kDa protein was identified by peptide mass fingerprinting as being related to vitamin D-binding protein. It was found in 96% of the sera from individuals with prostate cancer (n = 52) including 11 of 12 specimens that exhibited prostate-specific antigen values of less than 4 ng/mL. The 50.8-kDa protein was found in 10 of 19 samples from men with prostatic intraepithelial neoplasia; however, it was not detected in the sera of 5 (75%) of 20 individuals with benign prostatic histologic features, 7 (70%) of 10 with clinical benign prostatic hyperplasia, 8 (80%) of 10 patients who had previously undergone radical prostatectomy, or 48 (96%) of 50 specimens from healthy controls. CONCLUSIONS: Although the study cohort was relatively small, the data suggest that an assay for the 50.8-kDa protein may be useful for the early detection of prostate cancer. Additional elucidation of its structure may yield insight into the development of this disease.
