Case and Research Letter
Leukocytoclastic vasculitis related to cocaine-adulterated levamisole
Vasculitis leucocitoclástica relacionada con cocaína adulterada con levamisol
A. Imbernón-Moya
, R. Chico, I. de la Hera, M.Á. Gallego-Valdés
Autor para correspondencia
Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 – Leganés (Madrid), Spain
Leído
5309
Vecesse ha leído el artículo
1755
Total PDF
3554
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1578219016302682" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.10.001" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1427" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:795-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 562 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 386 "PDF" => 137 ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016302694" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.10.002" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1418" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:797-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 740 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 516 "PDF" => 181 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Father-to-Newborn Transmission of Herpes Simplex Virus Infection: A Sweet but Bitter Kiss" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "797" "paginaFinal" => "798" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Herpes neonatal tras contacto con herpes labial paterno: dulce y amargo beso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1020 "Ancho" => 951 "Tamanyo" => 166520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Groups of vesicles and pustules overlying erythematous skin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Guergué Diaz de Cerio, M. Rubio Lombraña, A. Barrutia Borque, M.R. González Hermosa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Guergué Diaz de Cerio" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rubio Lombraña" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Barrutia Borque" ] 3 => array:2 [ "nombre" => "M.R." "apellidos" => "González Hermosa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731016300825" "doi" => "10.1016/j.ad.2016.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016300825?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302694?idApp=UINPBA000044" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302694/v1_201611010039/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016302098" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.08.006" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "1409" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:793-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1445 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 1086 "PDF" => 314 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Clear Cell Acanthoma of the Areola and Nipple" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "793" "paginaFinal" => "795" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantoma de células claras de la aréola y el pezón" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1155 "Ancho" => 851 "Tamanyo" => 124142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, flaking, exudative erythematous plaque in the areola of the right breast. B, Complete resolution of the lesion in the areola of the right breast after 6 months of topical therapy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. Hidalgo-García, P. Gonzálvo, S. Mallo-García, C. Fernández-Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Hidalgo-García" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Gonzálvo" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Mallo-García" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Fernández-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016300667" "doi" => "10.1016/j.ad.2016.04.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016300667?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302098?idApp=UINPBA000044" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302098/v1_201611010039/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Leukocytoclastic vasculitis related to cocaine-adulterated levamisole" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "795" "paginaFinal" => "797" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Imbernón-Moya, R. Chico, I. de la Hera, M.Á. Gallego-Valdés" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" "email" => array:1 [ 0 => "adrian_imber88@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Chico" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "de la Hera" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Gallego-Valdés" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 – Leganés (Madrid), Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vasculitis leucocitoclástica relacionada con cocaína adulterada con levamisol" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1245 "Ancho" => 701 "Tamanyo" => 169186 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patches with a necrotic central area and erythematous borders on the right ear.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cocaine consumption has been increasing around the world in recent years and the associated complications are thus becoming more and more common.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Levamisole is often found in contaminated cocaine and can increase the length and intensity of the stimulant effect of this recreational drug.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 47-year-old man with no medical background of note attended the dermatology department for a 1-month history of painful skin lesions on both ears. He otherwise felt well. On further questioning, he denied having taken any new or different prescription drugs and reported no prodromal symptoms. However, he did state he was a smoker and a user of cocaine since the age of 25 years; of note, he had sniffed cocaine 3 days before the onset of the lesions.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At presentation, symmetrical, bilateral erythematous-violaceous patches were observed on his ears (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and on the lateral walls of the abdomen (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Over the following days, the lesions became infiltrated edematous papules and plaques that subsequently progressed to ulcerated necrotic plaques with an erythematous halo.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Full blood count and biochemistry were normal, including liver and kidney function tests. Urinalysis was unremarkable. Autoimmune screening revealed a polyclonal hypergammaglobulinemia, positive anticardiolipin M (48<span class="elsevierStyleHsp" style=""></span>U/ml), and positive antinuclear antibodies (titer, 1:160) with a speckled pattern. Complement was normal and the extractable nuclear antibodies panel (Smith, ribonucleoprotein, Ro, La, Scl-70, Jo-1), double-stranded DNA, antineutrophil cytoplasmic antibodies (ANCA), and cryoglobulins were negative. Serology for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) were negative and coagulation studies were normal. Chest X-ray did not show any relevant features. A full-thickness skin biopsy showed a leukocytoclastic vasculitis of the superficial and deep dermal and subcutaneous vascular plexuses, with some thrombotic features (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Urine drug screening was not performed. Based on these tests, we made a diagnosis of cutaneous leukocytoclastic vasculitis secondary to the use of levamisole-contaminated cocaine. The patient was treated with topical copper sulfate 1:1000 and betamethasone dipropionate, 0.05%, for 2 weeks, with an excellent response and complete clearance of the lesions without scarring, and no new lesions developed. The patient did not attend follow-up appointments.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Skin lesions are rare after cocaine use; they usually develop 1–4 days after exposure to the drug. The clinical spectrum can be broad and may be associated with digital vasospasm, Raynaud phenomenon, livedo reticularis, Buerger's disease, urticarial vasculitis, bullous diseases, acral ulcers, gangrene, and small and medium vessel vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Lesions usually have a rapid onset, with a painful violaceous rash that tends to ulcerate and become necrotic, typically affecting the face (ears and cheeks) and lower legs. Systemic complications are uncommon except for joint pain, which is common.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3–9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The pathogenesis of the condition is largely unknown, although some research points to tissue ischemia caused by blood vessel constriction, direct or indirect blood vessel damage induced by immune complexes, or thrombosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Histopathologic features can include vascular thrombosis and leukocytoclastic vasculitis, with or without fibrinoid necrosis. These are nonspecific features and can be found in many other disorders.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients may develop antiphospholipid antibodies (namely IgM anticardiolipin and lupus anticoagulant) and ANCA with a cytoplasmic (c-ANCA) or perinuclear (p-ANCA) pattern. C-ANCA antibodies almost exclusively target proteinase 3 (PR3) antigen whereas p-ANCA antibodies can bind multiple antigens, including myeloperoxidase, lactoferrin, human neutrophil elastase (HNE), and PR3; HNE is specifically targeted after cocaine use,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,4,10</span></a> and this may induce neutropenia in some patients,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,9</span></a> which can lead to confusion with other vasculitides, particularly with the ANCA-positive vasculitides (polyarteritis nodosa, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis). As no pathognomonic laboratory or histopathologic criteria exist, the diagnosis is purely clinic and is made by exclusion. A detailed clinical history and a high level of clinical suspicion are paramount.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3–9</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The diagnostic approach to cases of suspected cocaine-induced cutaneous vasculitis should include complete blood count, biochemistry including liver and kidney function tests, erythrocyte sedimentation rate, urinalysis, chest X-ray, fecal occult blood, full thickness skin biopsy, antiphospholipid antibodies, coagulation studies including homocysteine and proteins C and S, cryoglobulins, serum ANCA and ANA antibodies, double-stranded DNA antibodies, rheumatoid factor and complement levels, and serology for HIV, HBV, and HCV. Other tests such as blood, urine, or skin microbiology should be performed as required.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The skin lesions usually resolve within 2–3 weeks after cessation of cocaine use. Normalization of laboratory tests can take 2–14 months, though the neutropenia recovers fully in less than 10 days.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,5,7,8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There is no consensus regarding treatment of this condition. Obviously, removal of the cause is the most important measure, together with symptom relief. Good clinical outcomes have been reported with the use of nonsteroidal anti-inflammatory drugs for arthralgia and colchicine, dapsone, oral antihistamines, and pentoxifylline for the skin lesions.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,4</span></a> Systemic corticosteroids have not been shown to be effective.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1245 "Ancho" => 701 "Tamanyo" => 169186 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patches with a necrotic central area and erythematous borders on the right ear.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 535 "Ancho" => 949 "Tamanyo" => 81173 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patch with a necrotic central area and erythematous border on the abdomen.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1827 "Ancho" => 901 "Tamanyo" => 652470 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Leukocytoclastic vasculitis of the superficial and deep dermal vascular plexuses, with some thrombotic features. Hematoxylin and eosin, original magnification ×4. (B) Leukocytoclastic vasculitis with some thrombotic features. Hematoxylin and eosin, original magnification ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The head, neck, and systemic manifestations of levamisole-adulterated cocaine use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.R. Magliocca" 1 => "N.A. Coker" 2 => "S.R. Parker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.joms.2012.10.028" "Revista" => array:6 [ "tituloSerie" => "J Oral Maxillofac Surg" "fecha" => "2013" "volumen" => "71" "paginaInicial" => "487" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23298805" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levamisole in cocaine: unexpected news from an old acquaintance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Larocque" 1 => "R.S. Hoffman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Toxicol (Phila)" "fecha" => "2012" "volumen" => "50" "paginaInicial" => "231" "paginaFinal" => "241" "itemHostRev" => array:3 [ "pii" => "S0735109798004744" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limited cutaneous vasculitis associated with levamisole-adulterated cocaine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Yachoui" 1 => "S.L. Kolasinski" 2 => "H. Eid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4021/jocmr1003w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "358" "paginaFinal" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23024742" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leukocytoclastic vasculitis related to cocaine use" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Salas-Espíndola" 1 => "A. Peniche-Castellanos" 2 => "I. López-Gehrke" 3 => "P. Mercadillo-Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2011.01.014" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2011" "volumen" => "102" "paginaInicial" => "825" "paginaFinal" => "827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21803317" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levamisole-adulterated cocaine induced skin necrosis of nose, ears, and extremities. Case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.A. Lawrence" 1 => "J.L. Jiron" 2 => "H.S. Lin" 3 => "A.J. Folbe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Allergy Rhinol" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "132" "paginaFinal" => "136" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levamisole-adulterated cocaine induced vasculitis with skin ulcerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.T. Pillow" 1 => "A. Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5811/westjem.2012.9.12486" "Revista" => array:6 [ "tituloSerie" => "West J Emerg Med" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "149" "paginaFinal" => "150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23599853" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Levamisole-contaminated cocaine: an emergent cause of vasculitis and skin necrosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Souied" 1 => "H. Baydoun" 2 => "Z. Ghandour" 3 => "N. Mobarakai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2014/434717" "Revista" => array:5 [ "tituloSerie" => "Case Rep Med" "fecha" => "2014" "volumen" => "2014" "paginaInicial" => "434717" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24778656" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrosis of ears after use of cocaine probably adulterated with levamisole" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. de la Hera" 1 => "V. Sanz" 2 => "D. Cullen" 3 => "R. Chico" 4 => "G. Petiti" 5 => "M. Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000329436" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2011" "volumen" => "223" "paginaInicial" => "25" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21846960" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristic purpura of the ears, vasculitis, and neutropenia – a potential public health epidemic associated with levamisole-adulterated cocaine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Chung" 1 => "P.C. Tumeh" 2 => "R. Birnbaum" 3 => "B.H. Tan" 4 => "L. Sharp" 5 => "E. McCoy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2010.08.024" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2011" "volumen" => "65" "paginaInicial" => "722" "paginaFinal" => "725" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21658797" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PR3-ANCA-positive necrotizing multi-organ vasculitis following cocaine abuse" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Neynaber" 1 => "N. Mistry-Burchardi" 2 => "C. Rust" 3 => "W. Samtleben" 4 => "W.H. Burgdorf" 5 => "M.A. Seitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-0514" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2008" "volumen" => "88" "paginaInicial" => "594" "paginaFinal" => "596" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19002345" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016302682/v1_201611010039/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000009/v1_201611010039/S1578219016302682/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016302682?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 8 | 14 |
| 2024 Octubre | 67 | 57 | 124 |
| 2024 Septiembre | 78 | 21 | 99 |
| 2024 Agosto | 99 | 66 | 165 |
| 2024 Julio | 77 | 33 | 110 |
| 2024 Junio | 88 | 43 | 131 |
| 2024 Mayo | 69 | 37 | 106 |
| 2024 Abril | 82 | 18 | 100 |
| 2024 Marzo | 103 | 29 | 132 |
| 2024 Febrero | 78 | 31 | 109 |
| 2024 Enero | 68 | 35 | 103 |
| 2023 Diciembre | 73 | 18 | 91 |
| 2023 Noviembre | 99 | 30 | 129 |
| 2023 Octubre | 78 | 28 | 106 |
| 2023 Septiembre | 75 | 49 | 124 |
| 2023 Agosto | 44 | 14 | 58 |
| 2023 Julio | 70 | 45 | 115 |
| 2023 Junio | 59 | 41 | 100 |
| 2023 Mayo | 112 | 35 | 147 |
| 2023 Abril | 71 | 27 | 98 |
| 2023 Marzo | 56 | 32 | 88 |
| 2023 Febrero | 43 | 19 | 62 |
| 2023 Enero | 53 | 22 | 75 |
| 2022 Diciembre | 63 | 29 | 92 |
| 2022 Noviembre | 32 | 29 | 61 |
| 2022 Octubre | 37 | 16 | 53 |
| 2022 Septiembre | 16 | 22 | 38 |
| 2022 Agosto | 17 | 27 | 44 |
| 2022 Julio | 22 | 25 | 47 |
| 2022 Junio | 15 | 23 | 38 |
| 2022 Mayo | 45 | 35 | 80 |
| 2022 Abril | 46 | 27 | 73 |
| 2022 Marzo | 48 | 44 | 92 |
| 2022 Febrero | 57 | 21 | 78 |
| 2022 Enero | 80 | 37 | 117 |
| 2021 Diciembre | 60 | 28 | 88 |
| 2021 Noviembre | 53 | 42 | 95 |
| 2021 Octubre | 94 | 53 | 147 |
| 2021 Septiembre | 63 | 45 | 108 |
| 2021 Agosto | 87 | 20 | 107 |
| 2021 Julio | 70 | 21 | 91 |
| 2021 Junio | 43 | 17 | 60 |
| 2021 Mayo | 48 | 41 | 89 |
| 2021 Abril | 99 | 67 | 166 |
| 2021 Marzo | 66 | 23 | 89 |
| 2021 Febrero | 73 | 18 | 91 |
| 2021 Enero | 39 | 17 | 56 |
| 2020 Diciembre | 26 | 14 | 40 |
| 2020 Noviembre | 31 | 19 | 50 |
| 2020 Octubre | 23 | 11 | 34 |
| 2020 Septiembre | 34 | 10 | 44 |
| 2020 Agosto | 15 | 22 | 37 |
| 2020 Julio | 20 | 14 | 34 |
| 2020 Junio | 29 | 24 | 53 |
| 2020 Mayo | 16 | 17 | 33 |
| 2020 Abril | 29 | 9 | 38 |
| 2020 Marzo | 21 | 13 | 34 |
| 2020 Febrero | 6 | 0 | 6 |
| 2020 Enero | 5 | 0 | 5 |
| 2019 Diciembre | 7 | 0 | 7 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 7 | 1 | 8 |
| 2019 Abril | 5 | 6 | 11 |
| 2019 Marzo | 3 | 0 | 3 |
| 2019 Febrero | 5 | 0 | 5 |
| 2019 Enero | 4 | 0 | 4 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Febrero | 11 | 3 | 14 |
| 2018 Enero | 29 | 4 | 33 |
| 2017 Diciembre | 22 | 6 | 28 |
| 2017 Noviembre | 19 | 9 | 28 |
| 2017 Octubre | 21 | 7 | 28 |
| 2017 Septiembre | 17 | 5 | 22 |
| 2017 Agosto | 15 | 3 | 18 |
| 2017 Julio | 29 | 10 | 39 |
| 2017 Junio | 25 | 9 | 34 |
| 2017 Mayo | 18 | 2 | 20 |
| 2017 Abril | 14 | 4 | 18 |
| 2017 Marzo | 16 | 15 | 31 |
| 2017 Febrero | 12 | 4 | 16 |
| 2017 Enero | 9 | 8 | 17 |
| 2016 Diciembre | 22 | 11 | 33 |
| 2016 Noviembre | 32 | 30 | 62 |
Mostrar todo
