Cutaneous Necrosis, Purpura, and Neutropenia: Think Contaminated Cocaine
Clinicians at the University of Rochester saw 2 patients in just over 1 week who had necrotic skin lesions and neutropenia. Neither had a significant medical history other than recent cocaine use.
- A 57-year-old woman presented with fevers, chills, arthralgias, recurrent Staphylococcus aureus boils, and palpable necrotic purpuric plaques on her cheeks and earlobes. Her nadir absolute neutrophil count (ANC) was 500/mm3, her anticardiolipin antibody (ACA) level was medium-positive, and her perinuclear antineutrophil cytoplasmic antibody (P-ANCA) was positive. Biopsy of a lesion showed organizing thrombi in small vessels and perivascular lymphocytic infiltrates.
- A 22-year-old woman presented with tender plaques on her cheeks, legs, and buttocks and a necrotic lesion on her nose. Her ANC was <1000/mm3, and her P-ANCA and ACLA were positive. Biopsy results were consistent with leukocytoclastic vasculitis.