Vaskulitis der Haut nach Kokainkonsum

Zusammenfassung

Anamnese und klinischer Befund Ein 20-jähriger Patient stellte sich mit großflächigen und äußerst schmerzhaften Purpura mit Nekrosearealen und Vesikeln, vor allem an den unteren Extremitäten, aber auch an den Armen, am Stamm und an den Ohren in unserer Notaufnahme vor. Vorbestehend war ein Konsum von Kokain.

Untersuchungen In den Laboruntersuchungen zeigten sich erhöhte Entzündungszeichen sowie eine Erhöhung der Proteinase 3- und Myeloperoxidase-ANCA (Anti-Neutrophile cytoplasmatische Antikörper).

Diagnose In Zusammenschau der Anamnese, des klinischen Befundes und der Laborwerte zeigte sich eine Vaskulitis der Haut nach Kokainkonsum.

Therapie und Verlauf Unter einer Therapie mit Steroid sowie Drogenkarenz kam es zu einer Rückbildung der Veränderungen.

Folgerung Die Vaskulitis ist eine schwerwiegende Komplikation der Einnahme von Kokain.

Abstract

History and clinical findings A 20-years-old patient presented himself to our emergency room with extensive and extremely painful purpura with necrotizing spots and blisters, especially on the lower extremities, but also on the arms, trunk and ears. There was a pre-existing use of cocaine.

Medical examinations Laboratory tests showed increased signs of inflammation as well as an increase in proteinase 3- and myeloperoxidase-ANCA (Anti-neutrophil cytoplasmatic antibody).

Diagnosis In combination with the medical history, the clinical findings, and the laboratory values, vasculitis of the skin after cocaine use was revealed.

Therapy and course Under therapy with steroids and cocaine abstinence, there was a regression of the changes.

Conclusion Vasculitis is a serious complication of cocaine use.

Schlüsselwörter

Kokain - Levamisol - Vaskulitis - ANCA - Nekrose

Keywords

Cocaine - Levamisole - vasculitis - ANCA - necrosis

• Literatur

• 1 Europäischer Drogenbericht Trends und Entwicklungen 2022. 20222419_TDAT22001DEN_PDF.pdf (last accessed on 17 June 2023).
• 2 Tran H, Tan D, Marnejon TP. Cutaneous vasculopathy associated with levamisole-adulterated cocaine. Clin Med Res 2013; 11: 26-30
• 3 Chang A, Osterloh J, Thomas J. Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther 2010; 88: 408-411
• 4 Marquez J, Aguirre L, Muñoz C. et al. Cocaine-levamisole induced vasculitis/vasculopathy syndrome. Curr Rheumatol Rep 2017; 19: 1-5
• 5 Buchanan JA, Vogel JA, Eberhardt AM. Levamisole-induced occlusive necrotizing vasculitis of the ears after use of cocaine contaminated with levamisole. J Med Toxicol 2011; 7: 83-84
• 6 McGrath MM, Isakova T, Rennke HG. et al. Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease. Clin J Am Soc Nephrol 2011; 6: 2799-2805
• 7 Collister D, Sathianathan C, Ryz K. et al. ANCA associated vasculitis secondary to levamisole-adulterated cocaine with associated membranous nephropathy: A Case Series. Am J Nephrol 2017; 45: 209-216
• 8 van der Veer T, Pennings E, Tervaert JW. et al. Levamisole-contaminated cocaine: a hairy affair. BMJ Case Rep 2015;
• 9 Ullrich K, Koval R, Koval E. et al. Five consecutive cases of a cutaneous vasculopathy in users of levamisole-adulterated cocaine. J Clin Rheumatol 2011; 17: 193-196
• 10 Czuchlewski DR, Brackney M, Ewers C. et al. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010; 133: 466-472
• 11 Gross RL, Brucker J, Bahce-Altuntas A. et al. A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Clin Rheumatol 2011; 30: 1385-1392
• 12 Kintz P, Villain M, Cirimele V. Hair analysis for drug detection. Ther Drug Monit 2006; 28: 442-446
• 13 Lazareth H, Peytavin G, Polivka L. et al. The hairy-print for levamisole-induced vasculitis. BMJ Case Rep 2012;
• 14 Cohen Tervaer JW, Damoiseaux J. Antineutrophil cytoplasmic autoantibodies: how are they detected and what is their use for diagnosis, classification and follow-up. Clin Rev Allergy Immunol 2012;