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Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes.

Authors
  • Keim, Catherine K1
  • Schwartz, Robert A2
  • Kapila, Rajendra3
  • 1 Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ, 07103, USA. , (Jersey)
  • 2 Dermatology and Pathology, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ, 07103, USA. [email protected]. , (Jersey)
  • 3 Infectious Diseases, Rutgers New Jersey Medical School, MSB H-576, 185 South Orange Ave, Newark, NJ, 07103, USA. , (Jersey)
Type
Published Article
Journal
Archives of Dermatological Research
Publisher
Springer-Verlag
Publication Date
Mar 01, 2023
Volume
315
Issue
2
Pages
265–273
Identifiers
DOI: 10.1007/s00403-021-02303-1
PMID: 34807290
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura. © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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