Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis

Figures & data

Figure 2. Purpura involving the ear.

Figure 3. Retiform purpura in the leg.

Figure 4. 2X. Sections show a punch biopsy of skin. There is subepidermal edema with erythrocyte extravasation, Many superficial and deep dermal small vascular channels are surrounded by neutrophils and nuclear dust.

Figure 5. 40X. Neutrophils and nuclear dust in the blood vessel walls causing destruction of the blood vessel walls.

Figure 1. Retiform purpura in the arms.

Table

History of ingestion	High index of suspicion in setting associated cocaine/drug use
Constitutional symptoms	Fever, night sweats, weight loss and arthralgia
Skin manifestations	Purpura (retiform classically), necrosis, abscesses and bullae
Renal manifestations	Microscopic hematuria, proteinuria, elevated creatinine, features of pauci immune glomerulonephritis of renal biopsy
Pulmonary manifestations	Bronchitis, bronchiolitis, interstitial pneumonia, nodules and hemorrhage
Serology	Low complements, ANCA (MPO/PR3), ANA, dsDNA, lupus anticoagulant,

The above criteria are not absolute and the aforementioned features might occur in isolation or in varied combinations