Gillette Wesley M, Singh Sonali
Department of Ophthalmology, Baylor Scott & White Health System, Temple, Texas.
Department of Ophthalmology, Central Texas Veterans Health Care System, Temple, Texas.
Proc (Bayl Univ Med Cent). 2022 Apr 22;35(4):534-536. doi: 10.1080/08998280.2022.2057157. eCollection 2022.
A 57-year-old man with a history of cocaine dependence presented with acute left-sided preseptal cellulitis preceded by polyarthralgias, fever, and malaise. He endorsed numerous past episodes of alternating right- and left-sided eyelid edema over 10 years, always occurring within 12 hours to 1 week following cocaine use. While in the hospital, he developed worsening eyelid edema with purpura, dactylitis, and ulcerations of his oral mucosa and lower extremity. Laboratory findings were significant for a urine drug screen positive for cocaine, elevated perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) and anti-nuclear antibody (ANA) titers, and elevated SS-A, SS-B, and anti-Smith autoantibodies. An oral prednisone taper was initiated for a presumed diagnosis of levamisole-induced vasculitis with brisk resolution.
一名有可卡因依赖史的57岁男性，在出现多关节痛、发热和不适后，出现急性左侧眶隔前蜂窝织炎。他承认在过去10年中有多次右侧和左侧眼睑交替水肿发作，总是在使用可卡因后12小时至1周内出现。住院期间，他的眼睑水肿加重，并伴有紫癜、指（趾）炎以及口腔黏膜和下肢溃疡。实验室检查结果显示，尿液药物筛查可卡因呈阳性，核周抗中性粒细胞胞浆抗体（p-ANCA）和抗核抗体（ANA）滴度升高，以及SS-A、SS-B和抗史密斯自身抗体升高。鉴于推测诊断为左旋咪唑诱导的血管炎，开始口服泼尼松逐渐减量，症状迅速缓解。
