Table 3 Skin biopsy findings, treatment, and response to treatment information of all reported cases of levamisole-induced cutaneous vasculitis
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 |