Background
Case presentation
Discussion
Authors | Age/Sex | Clinical findings |
---|---|---|
Gross RL et al.[3] | 50 years/M | Retiform pupuric plaques with ulceration on earlobes/helix and lower extremities |
42 years/M | Reticulate pink/purple erythematous eruptions on legs, chest, arms, and back | |
42 years/F | Violaceous papules, reticular-purpuric plaques on arms, breasts, legs, and ears | |
59 years/F | Purpuric, necrotic plaques and bullae on face, ears, arms, right cheek, chest, and axilla | |
Ullrich K et al.[4] | 45 years/M | Painful necrotic purpura and skin nodules on extremities and ears |
49 years/F | Painful purpura on extremities, trunk, and earlobes | |
27 years/F | Painful purpura on lower extremities, arthralgia | |
29 years/F | Purpuric lesion with central necrosis on left foot, purpuric lesions on both ears | |
55 years/F | Episodic rash on face, trunk, and extremities | |
Bradford M et al.[7] | 57 years/F | Purpuric plaques with central necrosis on cheeks and earlobes |
22 years/F | Erythematous plaques with central necrosis on face, ears, legs, thighs, and buttocks | |
Buchanan JA et al.[8] | Not specified/M | Purple discoloration on left upper arm and right second toe, bilateral necrosis of ears |
Walsh NMG et al.[9] | 39 years/F | Retiform purpura, hemorrhagic bullae on legs, trunks, and buttocks |
49 years/F | Retiform purpura on chest, limbs, bilateral nasal mucosal ulcers | |
Waller JM et al.[10] | 38 years/F | Retiform purpura with central necrosis on earlobes, cheeks, breast, extremities |
43 years/F | Retiform purpura with central necrosis on legs, arms, and pinna; livedo racemosa, splinter hemorrhages | |
Farhat EK et al.[11] | 43 years/F | Retiform purpura with central necrosis on bilateral lower extremities |
41 years/F | Painful retiform purpuric patches on thighs, buttocks, trunk, upper extremities, and nasal tip | |
Click J[12] | 29 years/F | Calf ulcerations, retiform purpura |
Geller L et al.[13] | 50 years/F | Stellate purpura with central necrosis on upper extremities, ears, back, and breasts |
Han C et al.[14] | 52 years/F | Painful retiform purpura with ulceration on arms, legs, nasal tip, cheeks, ears |
Ching J et al.[15]/ Mouzakis J et al.[16] | 54 years/F | Purpuric patches and plaques on legs, upper extremities, perinasal area, anterior trunk, face, and ears |
Jacob RS et al.[17] | 41 years/F | Tender purpuric patches and plaques on ears, legs, upper extremities, back, toes, and soles |
48 years/F | Tender purpuric patches and plaques on ears and left cheek | |
Lung D et al.[18] | 44 years/F | Stellate, purpuric macules and plaques with central necrosis on legs, abdomen, and face |
Zwang NA et al.[19] | 52 years/M | Violaceous retiform papules/plaques on arms, legs, back, trunk, scalp, buttocks, fingers, foot, and ear |
Chung C et al.[20] | 46 years/F | Purpura and necrosis on bilateral ears, cheeks, and upper and lower extremities |
46 years/F | Bilateral ear necrosis, diffuse retiform purpura with necrosis on neck, trunk, and extremities | |
37 years/M | Tender bilateral ear purpura and necrosis, diffuse retiform purpura on trunk and extremities | |
50 years/M | Tender purpura and necrosis on both ears, purpura and bullae on trunk and extremities | |
Jenkins J et al.[21] | 47 years/M | Painful retiform purpura with necrotic center on legs, ears, cheek, tongue, trunk, and genitalia |
John S et al.[22] | 52 years/F | Painful violaceous plaques and flaccid bullae on right ankle, legs, left arm, and left breast |
Arora et al. [current report] | 44 years/F | Erythematous purpuric lesions with central necrosis on nose, cheeks, earlobes, and extremities |
Authors | Age/Sex | Leucopenia and/or Neutropenia | Antibodies present |
---|---|---|---|
Gross RL et al.[3] | 50 years/M | Yes, WBC -3,300/μL, ANC -2400/μL | p-ANCA, ANA, LAC, c-ANCA, anti-ds-DNA |
42 years/M | Yes, WBC -3,200/μL, ANC - 800/μL | p-ANCA, ANA, LAC, c-ANCA, IgM ACL | |
42 years/F | No | p-ANCA, c-ANCA, ANA | |
59 years/F | No | p-ANCA, ANA, anti-RNP | |
Ullrich K et al.[4] | 45 years/M | Yes, WBC -1,900/μL, ANC -1,000/μL | p-ANCA, c-ANCA, ANA, IgM ACL |
49 years/F | Yes, WBC -3,500/μL, ANC – 0 (zero) | ANA, c-ANCA | |
27 years/F | Yes, WBC -1,800/μL, ANC -400/μL | p-ANCA, c-ANCA, IgM ACL, ANA | |
29 years/F | No | p-ANCA, c-ANCA, IgM ACL, ANA | |
55 years/F | Yes, WBC -3,700/μL, ANC -2,300/μL | p-ANCA, c-ANCA, IgM ACL | |
Bradford M et al.[7] | 57 years/F | Yes, ANC -500/μL | p-ANCA, IgM ACL |
22 years/F | Yes, ANC < 1,000/μL | p-ANCA, IgM ACL | |
Buchanan JA et al.[8] | Not specified/M | Yes, WBC -1,900/μL | Not reported |
Walsh NMG et al.[9] | 39 years/F | No | p-ANCA, c-ANCA, ANA, LAC, anti-HNE |
49 years/F | Yes, WBC -2,000/μL, ANC -400/μL | p-ANCA, c-ANCA, ANA, anti-HNE | |
Waller JM et al.[10] | 38 years/F | Yes, ANC -550/μL | p-ANCA, c-ANCA, LAC |
43 years/F | Yes, ANC -560/μL | p-ANCA, IgM ACL, LAC, anti-ds-DNA, | |
Farhat EK et al.[11] | 43 years/F | No | p-ANCA |
41 years/F | No | p-ANCA, IgM ACL | |
Click J[12] | 29 years/F | No | p-ANCA, c-ANCA, ANA |
Geller L et al.[13] | 50 years/F | Yes, WBC -2,700/μL, ANC -1,400/μL | p-ANCA, IgM ACL |
Han C et al.[14] | 52 years/F | Yes, WBC -2,400/μL, ANC -1,400/μL | p-ANCA, c-ANCA, IgM ACL |
Ching J et al.[15]/ Mouzakis J et al.[16] | 54 years/F | Yes, WBC -3,900/μL, ANC -300/μL | p-ANCA, IgM ACL |
Jacob RS et al.[17] | 41 years/F | Yes, WBC -1,100/μL, ANC -670/μL | p-ANCA, c-ANCA, IgM ACL, ANA, anti-ds-DNA,anti-HNE |
48 years/F | Yes, WBC -800/μL, ANC -300/μL | p-ANCA, c-ANCA, IgM ACL, ANA, anti-ds-DNA,anti-HNE | |
Lung D et al.[18] | 44 years/F | Yes, ANC -270/μL | Not reported |
Zwang NA et al.[19] | 52 years/M | No | p-ANCA, c-ANCA, IgM ACL, ANA, LAC, anti-HNE, anti-ds-DNA, |
Chung C et al.[20] | 46 years/F | No | p-ANCA, c-ANCA, IgM ACL |
46 years/F | Yes, WBC and ANC not specified | p-ANCA, c-ANCA, IgM ACL | |
37 years/M | No | p-ANCA, ANA | |
50 years/M | No | p-ANCA, ANA | |
Jenkins J et al.[21] | 47 years/M | No | p-ANCA |
John S et al.[22] | 52 years/F | Yes, WBC -2,900/μL, ANC -638/μL | p-ANCA +, anti ds-DNA+ |
Arora et al. [current report] | 44 years/F | Yes, WBC -2,600/μL, ANC -900/μL | p-ANCA+, LAC+ |
Authors | Age/Sex | Pathology | Treatment | Response |
---|---|---|---|---|
Gross RL et al.[3] | 50 years/M | Vasculitis, thrombosis, necrosis | Oral prednisone, surgical debridement | Lesions remained stable, developed auditory hallucinations & superinfection |
42 years/M | Small-vessel vasculitis | Supportive care | Lesions improved without any intervention | |
42 years/F | Lekocytoclastic vasculitis, thrombosis | Oral prednisone | Lesions improved in one week | |
59 years/F | Small-vessel vasculitis, thrombosis | Oral prednisone | Lost to follow-up | |
Ullrich K et al.[4] | 45 years/M | Not reported | Oral prednisone | Initially improved, but symptoms recurred with attempts to taper the steroid dose |
49 years/F | Thrombosis, perivascular neutrophils, and karyorrhetic debris | Supportive, G-CSF | Resolution of lesions with abstinence from cocaine | |
27 years/F | Lekocytoclastic vasculitis, thrombosis | Oral prednisone | Lesions resolved with abstinence, arthralgia and neutropenia improved rapidly with prednisone | |
29 years/F | Not reported | Supportive care, oral steroids | Lesions resolved with abstinence, septal perforation & arthralia improved with steroids | |
55 years/F | Lekocytoclastic vascultis, thrombosis | Steroids, cyclophosphamide | Rapid resolution of lesions | |
Bradford M et al.[7] | 57 years/F | Intravascular thrombosis, no vasculitis | Filgrastim for neutropenia | Lesions resolved spontaneously, neutropenia improved with filgrastim |
22 years/F | Leucocytoclastic vasculitis, thrombosis | Steroids | Lesions and neutropenia improved rapidly | |
Buchanan JA et al.[8] | Not specified/M | Not done | Subcutaneous phentolamine to both ears | No improvement |
Walsh NMG et al.[9] | 39 years/F | Thrombosis, leucocytoclastic vasculitis | Anticoagulation, skin debridement and grafting | No new lesions with discontinuation of cocaine, skin lesions healed after multiple full thickness skin grafts |
49 years/F | Thrombosis, no evidence of vasculitis | Supportive care | Lesions improved, recurrences with cocaine use | |
Waller JM et al.[10] | 38 years/F | Leukocytoclastic vasculitis, thrombosis | Supportive care | Lesions improved, recurrences with cocaine use |
43 years/F | Thrombosis of dermal vessels | Supportive care | Lesions improved, recurrences with cocaine use | |
Farhat EK et al.[11] | 43 years/F | Extensive thrombosis, no vasculitis | Supportive care | Not specified |
41 years/F | Thrombosis with no vasculitis | Not specified | Not specified | |
Click J[12] | 29 years/F | Subepidermal bullous dermatitis, lymphocytic perivascular infiltrate | Skin grafts | Lesions were healing well after 4 months |
Geller L et al.[13] | 50 years/F | Lecocytoclastic vasculitis, thrombosis | Not specified | Not specified |
Han C et al.[14] | 52 years/F | Thrombotic vasculopathy, no vasculitis | Steroids (iv & oral), dalteparin, warfarin | Lesions and neutropenia improved, had recurrences in with repeat cocaine use, which improved with oral prednisone |
Ching J et al.[15]/ Mouzakis J et al.[16] | 54 years/F | Small vessel thrombosis, perivascular mononuclear infiltrates | IV steroids, left AKA, skin debridement, allografts | Developed extensive skin necrosis requiring debridement and skin grafts |
Jacob RS et al.[17] | 41 years/F | Epidermal necrosis, vascular thrombosis, leukocytoclasis | Oral prednisone | Resolution of the majority of the patient’s lesions |
48 years/F | Lymphocytic infiltrate, occlusive vasculopathy, neovascularization | Oral prednisone | Lesions improved | |
Lung D et al.[18] | 44 years/F | Extensive thrombotic vasculopathy | Not specified | Not specified |
Zwang NA et al.[19] | 52 years/M | Leukocytoclastic vasculitis | Oral prednisone | Lesions healed completely in 3 weeks |
Chung C et al.[20] | 46 years/F | Small-vessel vascultits with thrombosis | Steroids | Initial improvement, lost to follow-up |
46 years/F | Multiple Intravascular thrombi | IV methyl-prednisolone | Gradual improvement initially, lost to follow-up | |
37 years/M | Leucocytoclastic vasculitis | Supportive | Rapid improvement of skin lesions | |
50 years/M | Leucocytoclastic vasculitis, panniculitis | Supportive, antibiotics | Rapid improvement of skin lesions | |
Jenkins J et al.[21] | 47 years/M | Leucocytoclastic vascultits, occlusive vasculopathy | Oral & topical steroids, aspirin, pentoxifylline | Lesions resolved over 3 months |
John S et al.[22] | 52 years/F | Thrombotic vasculopathy, no vasculitis | Supportive, surgical debridement | Had new lesions with repeat cocaine use and necrotic ulceration of old lesions requiring surgical debridement |
Arora et al. [current report] | 44 years/F | Leucocytoclastic vasculitis, thrombosis | Surgical debridement, pain control, AKA, IV methyl-prednisolone for recurrent lesions | Recurrent lesions improved significantly with IV methylprednisolone |