Department of Internal Medicine, Cleveland Clinic, Ohio 44195, USA.
Am J Med Sci. 2011 Dec;342(6):524-6. doi: 10.1097/MAJ.0b013e31822979f1.
Cocaine has been associated with a number of cutaneous manifestations, and most reports in the literature have described cocaine-induced vasculitis. However, not all reactive patterns secondary to cocaine use are vasculitic in nature. Recently, there has been a disturbing trend of "cutting" cocaine with pharmacologically active substances, the most common being levamisole. This agent is known to cause serious adverse effects including agranulocytosis and cutaneous eruptions. The authors describe a 52-year-old woman who acutely developed an extensive bullous rash in the lower extremities after she snorted cocaine. The clinical, hematological and serological findings were suggestive of levamisole-induced vasculitis, but histopathology of the skin showed thrombogenic vasculopathy with no inflammatory infiltrate. A skin biopsy is an essential component in the diagnosis of cocaine-related syndromes and can aid in the distinction from true autoimmune vasculitis.
可卡因可引起多种皮肤表现，且大多数文献中的报告都描述了可卡因引起的血管炎。然而，并非所有继发于可卡因使用的反应性模式都是血管炎性质的。最近，出现了一种令人不安的趋势，即“切割”可卡因，加入有药理活性的物质，最常见的是左旋咪唑。这种药物会导致严重的不良反应，包括粒细胞缺乏症和皮肤疹。作者描述了一位 52 岁女性，她在吸食可卡因后下肢突然出现广泛大疱性皮疹。临床、血液学和血清学检查提示左旋咪唑引起的血管炎，但皮肤组织病理学显示血栓性血管病，无炎症浸润。皮肤活检是诊断与可卡因相关综合征的重要组成部分，有助于与真正的自身免疫性血管炎区分开来。
