A Case of Cutaneous Vasculitis in the Setting of Systemic Lupus Erythematosus and Cocaine Use

• Published in: JIM - high impact case reports Vol. 11; p. 23247096231176215
• Main Authors: Jaenke, Chad M., Moore, Sara R., Miller, Matthew D., Garg, Anu
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2023; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Case Report; Cocaine; Cocaine - adverse effects; Cocaine-Related Disorders - complications; Drug use; Female; Humans; Levamisole - adverse effects; Lupus; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Skin Diseases, Vascular - chemically induced; Skin Diseases, Vascular - diagnosis; Vein & artery diseases; rheumatology; systemic lupus erythematosus; levamisole-cocaine-induced vasculitis
• ISSN: 2324-7096; 2324-7096
• DOI: 10.1177/23247096231176215

Cocaine, one of most prevalent illicit substances in the United States, affects a multitude of organ systems and precedes numerous negative health outcomes. Many of the consequences of cocaine are linked to induction of vasoconstriction. For this reason, cocaine users are placed at considerable risk of ischemic stroke, myocardial infarction, and cardiac arrhythmias. Furthermore, a prominent contaminant, levamisole, has been widely implicated in predisposing individuals to developing or exacerbating cutaneous vasculitides. This report details a 31-year-old woman with acute, localized necrotic skin lesions after cocaine use. Her clinical picture was complicated by a 17-year history of systemic lupus erythematosus (SLE) and Raynaud’s phenomenon. This case examines the challenge of forming a differential diagnosis, initiating an appropriate workup, and interpreting serologic-based and immunologic-based studies to differentiate between SLE and drug-based etiologies of skin necrosis. Finally, we discuss appropriate treatment plans to mitigate symptoms and reduce future instances of drug-induced vasculitis.