Latif Zara, Pour-Ghaz Issa, Bergeron Jaclyn B
Internal Medicine, University of Tennessee Health Science Center, Memphis, USA.
Internal Medicine, Methodist University Hospital, Memphis, USA.
Cureus. 2019 Jul 22;11(7):e5198. doi: 10.7759/cureus.5198.
Purpura in hepatitis C patients has a wide range of possible etiologies, some of which include mixed cryoglobulinemia and idiopathic thrombocytopenic purpura. Levamisole is a common chemical used as a lacing agent for cocaine. It is believed to enhance the addictive properties of cocaine, but it has been associated with a vasculitis syndrome that most commonly presents with purpura and leukopenia. We report a case of a patient with hepatitis C and cocaine abuse who presented with vasculitis, thrombocytopenia, and bloody sputum. A punch biopsy was performed, which confirmed the diagnosis of levamisole-induced vasculitis. A comprehensive rheumatology workup could result in variable serology and does not provide a definitive diagnosis. We suggest performing a punch biopsy as part of the initial workup for these patients, as it can provide rapid diagnosis and is associated with a lower cost.
丙型肝炎患者的紫癜有多种可能病因，其中一些包括混合性冷球蛋白血症和特发性血小板减少性紫癜。左旋咪唑是一种常见的化学物质，用作可卡因的掺杂剂。据信它会增强可卡因的成瘾性，但它与一种血管炎综合征有关，该综合征最常见的表现为紫癜和白细胞减少。我们报告一例丙型肝炎合并可卡因滥用的患者，该患者出现血管炎、血小板减少和咯血。进行了皮肤打孔活检，确诊为左旋咪唑诱导的血管炎。全面的风湿病检查可能会得出不同的血清学结果，且无法提供明确诊断。我们建议对这些患者进行皮肤打孔活检作为初始检查的一部分，因为它可以快速诊断且成本较低。
