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Vasculitis due to levamisole-adulterated cocaine
  1. Vishnu Mohan1,
  2. Abhishek Maiti1,
  3. Michael G Swaby2,
  4. Sujith V Cherian1,3
  1. 1Department of Internal Medicine, The University of Texas Health Science Centre at Houston, Houston, Texas, USA
  2. 2Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
  3. 3Department of Internal Medicine, Division of Critical Care, Pulmonary and Sleep Medicine, The University of Texas Health Science Centre at Houston, Houston, Texas, USA
  1. Correspondence to Dr Sujith V Cherian, Department of Internal Medicine, Division of Critical Care, Pulmonary and Sleep Medicine ,The University of Texas Health Science Centre at Houston, Houston, Texas 77030, USA; Sujith.V.Cherian{at}uth.tmc.edu

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A 68-year-old woman presented with skin lesions for 1 week. She reported similar lesions 6 months before, which had resolved within a few weeks. Physical examination showed haemorrhagic lesions over forearms and face with bullae (figure 1A,B). Laboratory tests revealed pancytopaenia with neutropaenia. Antinuclear antibody, perinuclear antineutrophil cytoplasmic antibody (p-ANCA), antiproteinase-3 (anti-PR3) and antimyeloperoxidase (anti-MPO) antibodies were positive with high titres. Complement levels were normal. Cryoglobulin and rheumatoid factor were negative. Urine toxicology screen was positive for cocaine. Skin biopsy showed leukocytoclastic …

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