Shawwa Khaled, Alraiyes Abdul Hamid, Eisa Naseem, Alraies M Chadi
American University of Beirut Medical Center, Beirut, Lebanon.
BMJ Case Rep. 2013 Aug 30;2013:bcr2013200507. doi: 10.1136/bcr-2013-200507.
A 48-year-old woman presented with a red, pruritic and painful skin rash on her legs bilaterally after she snorted cocaine. This was associated with fever and cough. Physical examination showed large violaceous plaques and large flaccid bullae, involving bilateral lower extremities. Blood work showed neutropoenia with absolute neutrophil count of 0.64×10(9) cells/L. Antinuclear antibody, perinuclear antineutrophil cytoplasmic antibody and anti-double-stranded DNA were positive. Biopsy showed thrombogenic vasculopathy which is consistent mainly with levamisole ingestion that was reported with levamisole ingestion. The patient was counselled to stop cocaine misuse and treated with skin emollients and antibiotics for the pneumonia that was discovered on the chest X-ray. Skin ulcers improved and she was discharged in stable condition. Ten days after discharge, she was readmitted with new lesions and worsening necrotic ulcers from the old lesions. The patient admitted to snorting cocaine again a few days after being discharged.
一名48岁女性在吸食可卡因后双侧腿部出现红色、瘙痒且疼痛的皮疹。这伴有发热和咳嗽。体格检查显示双侧下肢有大片紫蓝色斑块和大的松弛水疱。血液检查显示中性粒细胞减少，绝对中性粒细胞计数为0.64×10⁹/L。抗核抗体、核周抗中性粒细胞胞浆抗体和抗双链DNA均为阳性。活检显示血栓形成性血管病，这主要与摄入左旋咪唑一致，此前有报道称摄入左旋咪唑会出现这种情况。建议患者停止滥用可卡因，并使用皮肤润肤剂和抗生素治疗胸部X线检查发现的肺炎。皮肤溃疡有所改善，患者出院时情况稳定。出院十天后，她因出现新的皮损以及原有皮损处坏死溃疡恶化再次入院。患者承认出院几天后又吸食了可卡因。
