Jacob Reza S, Silva Claudine Yap, Powers Jennifer G, Schieke Stefan M, Mendese Gary, Burlingame Rufus W, Miller Daniel D, Wolpowitz Deon, Graber Emmy, Mahalingam Meera
Department of Dermatology, Boston University School of Medicine,609 Albany Street, Boston, MA 02118, USA.
Am J Dermatopathol. 2012 Apr;34(2):208-13. doi: 10.1097/DAD.0b013e31821cc0bf.
Although cocaine-induced pseudovasculitis and urticarial vasculitis have been reported in the past, levamisole-induced vasculopathy with ecchymosis and necrosis, termed here LIVEN, has only recently been described in association with cocaine use. Levamisole, a veterinary antihelminthic agent used previously as an immunomodulating agent, is present as a "cutting agent" in approximately two-thirds of the cocaine currently entering the United States. Levamisole is believed to potentiate the effects of cocaine and may also be used as a "signature" for tracing its market distribution. Herein, we report 2 cases of LIVEN in patients with histories of chronic cocaine use. In both the cases, a temporal association with neutropenia preceding the eruption was noted. A novel histopathologic finding present only in the second case was the presence of extensive interstitial and perivascular neovascularization. Our 2 cases reaffirm that neutropenia may precede the cutaneous eruption of LIVEN. Case 2 extends the spectrum of histopathologic findings to include the novel phenomenon of neovascularization-hitherto unreported in this entity.
尽管过去已有可卡因诱发假性血管炎和荨麻疹性血管炎的报道，但左旋咪唑诱发的伴有瘀斑和坏死的血管病变（本文称为LIVEN），直到最近才被描述为与可卡因使用有关。左旋咪唑是一种曾用作免疫调节剂的兽用抗蠕虫药，在目前进入美国的约三分之二的可卡因中作为“掺杂物”存在。据信，左旋咪唑可增强可卡因的作用，还可能被用作追踪其市场分布的“标记物”。在此，我们报告2例有慢性可卡因使用史的LIVEN患者。在这2例病例中，均注意到皮疹出现前与中性粒细胞减少存在时间上的关联。仅在第二例中出现的一个新的组织病理学发现是广泛的间质和血管周围新生血管形成。我们的2例病例再次证实中性粒细胞减少可能先于LIVEN的皮肤皮疹出现。病例2扩展了组织病理学发现的范围，将新生血管形成这一新现象纳入其中——此前该实体中未曾有过相关报道。
