CME ARTICLE
Occlusive cutaneous vasculopathies: rare differential diagnoses
Maria Rosa Burg,
Inga Hansen,
Leopold Konstantin Torster,
Stefan Werner Schneider,
Maria Rosa Burg
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorInga Hansen
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorLeopold Konstantin Torster
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorCorresponding Author
Stefan Werner Schneider
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Correspondence
Prof. Dr. med. Stefan Werner Schneider, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Email: [email protected]
Maria Rosa Burg
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG, DGDC, HDG
Inga Hansen
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG, DGDC, NDG
Leopold Konstantin Torster
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG
Stefan Werner Schneider
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: HDG, DDG
Search for more papers by this authorMaria Rosa Burg,
Inga Hansen,
Leopold Konstantin Torster,
Stefan Werner Schneider,
Maria Rosa Burg
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorInga Hansen
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorLeopold Konstantin Torster
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Search for more papers by this authorCorresponding Author
Stefan Werner Schneider
Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Correspondence
Prof. Dr. med. Stefan Werner Schneider, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
Email: [email protected]
Maria Rosa Burg
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG, DGDC, HDG
Inga Hansen
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG, DGDC, NDG
Leopold Konstantin Torster
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: DDG
Stefan Werner Schneider
Finanzielle Interessen: Nein
Erklärung zu nicht-finanziellen
Interessen: HDG, DDG
Search for more papers by this authorFirst published: 04 April 2025
Maria Rosa Burg and Inga Hansen contributed equally to this article.
Summary
In addition to erythematous plaques, nodules, ulcerations, and necrosis, retiform purpura and livedo racemosa are indications of occlusive cutaneous vasculopathies. In contrast to cutaneous vasculitis, occlusive cutaneous vasculopathies primarily lead to vascular occlusion of the skin and only secondarily to signs of vascular inflammation. The lower legs are typically affected, but especially in the presence of acral skin changes, occlusive cutaneous vasculopathies should also be considered. Various stimuli can trigger occlusive cutaneous vasculopathies, including systemic or vascular coagulopathies, emboli, platelet or erythrocyte aggregates, cold-dependent gelling and agglutination of immunoglobulins, or, less commonly, medications.
CONFLICT OF INTEREST STATEMENT
None.
REFERENCES
- 1Sunderkötter CH, Zelger B, Chen KR, et al. Nomenclature of Cutaneous Vasculitis: Dermatologic Addendum to the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheumatol. 2018; 70(2): 171-184.
- 2Sunderkötter C. Vaskulitis und Vaskulopathien. In: G Plewig, T Ruzicka, R Kaufmann, M Hertl, eds. Braun-Falco's Dermatologie, Venerologie und Allergologie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2018: 1139-1182.
10.1007/978-3-662-49544-5_64 Google Scholar
- 3Llamas-Velasco M, Alegria V, Santos-Briz A, et al. Occlusive Nonvasculitic Vasculopathy. Am J Dermatopathol. 2017; 39(9): 637-662.
- 4Georgesen C, Fox LP, Harp J. Retiform purpura: A diagnostic approach. J Am Acad Dermatol. 2020; 82(4): 783-796.
- 5Weishaupt C, Strolin A, Kahle B, et al. Characteristics, risk factors and treatment reality in livedoid vasculopathy - a multicentre analysis. J Eur Acad Dermatol Venereol. 2019; 33(9): 1784-1791.
- 6Ratzinger G, Zelger BG, Zelger BW. Bar code reader - an algorithmic approach to cutaneous occluding vasculopathies? Part I: small vessel vasculopathies. J Dtsch Dermatol Ges. 2019; 17(9): 895-904.
- 7Ratzinger G, Zelger BG, Zelger BW. Bar Code Reader – an algorithmic approach to cutaneous occluding vasculopathies? Part II medium vessel vasculopathies. J Dtsch Dermatol Ges. 2019; 17(11): 1115-1128.
10.1111/ddg.13973 Google Scholar
- 8Ronicke M, Berking C, Erfurt-Berge C. Occlusive cutaneous vasculopathies as cause of chronic ulcers. J Dtsch Dermatol Ges. 2024; 22(4): 553-567.
- 9Ozkok A. Cholesterol-embolization syndrome: current perspectives. Vasc Health Risk Manag. 2019; 15: 209-220.
- 10Shah N, Nagalli S. Cholesterol Emboli. In: StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Shivaraj Nagalli declares no relevant financial relationships with ineligible companies.: StatPearls Publishing. Copyright © 2024, StatPearls Publishing LLC.; 2024.
- 11Avci G, Akoz T, Gul AE. Cutaneous cholesterol embolization. J Dermatol Case Rep. 2009; 3(2): 27-29.
- 12Ghanem F, Vodnala D, J KK, et al. Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features. J Biomed Res. 2017; 31(2): 82-94.
- 13Toriu N, Sumida K, Mizuno H, et al. Long-term outcome of biopsy-proven cholesterol crystal embolism. Clin Exp Nephrol. 2019; 23(10): 1181-1187.
- 14Karch J, Raja A, De La Garza H, et al. Part I: Cutaneous manifestations of cardiovascular disease. J Am Acad Dermatol. 2023; 89(2): 197-208.
- 15Takahashi K, Omuro A, Ohya M, et al. Incidence, Risk Factors, and Prognosis of Cholesterol Crystal Embolism Because of Percutaneous Coronary Intervention. Am J Cardiol. 2022; 167: 15-19.
- 16Tartari F, Di Altobrando A, Merli Y, et al. Blue Toe Syndrome: A Challenging Diagnosis. Indian J Dermatol. 2019; 64(6): 506-507.
- 17Esson GA, Hussain AB, Meggitt SJ, et al. Cutaneous manifestations of acute kidney injury. Clin Kidney J. 2022; 15(5): 855-864.
- 18Rousseau A, de Monchy I, Barreau E, et al. Retinal emboli in cholesterol crystal embolism. Case Rep Ophthalmol Med. 2013; 2013:421352.
- 19Oka H, Kamimura T, Hiramatsu Y, et al. Cholesterol Crystal Embolism Induced by Direct Factor Xa Inhibitor: A First Case Report. Intern Med. 2018; 57(1): 71-74.
- 20Carlson JA, Chen KR. Cutaneous pseudovasculitis. Am J Dermatopathol. 2007; 29(1): 44-55.
- 21Ogbechie OA, Morley KW, Sugai D, et al. Limited cutaneous pseudovasculitis: a mild variant of cholesterol emboli syndrome. Circulation. 2015; 131(5): 514-515.
- 22Tian M, Matsukuma KE. Cholesterol crystal embolism to the gastrointestinal tract: a catastrophic case. Autops Case Rep. 2019; 9(2):e2018082.
- 23Bolton L. Does Hyperbaric Oxygen Improve Lower Extremity Ulcer Outcomes? Wounds. 2020; 32(10): 291-293.
- 24Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017; 129(21): 2864-2872.
- 25Nicolas D, Nicolas S, Hodgens A, Reed M. Heparin-Induced Thrombocytopenia. In: StatPearls. Treasure Island (FL), 2024.
- 26Chong BH, Ismail F. The mechanism of heparin-induced platelet aggregation. Eur J Haematol. 1989; 43(3): 245-251.
- 27Greinacher A. Heparin-Induced Thrombocytopenia. N Engl J Med. 2015; 373(19): 1883-1884.
- 28Warkentin TE, Kelton JG. Heparin-induced thrombocytopenia. Prog Hemost Thromb. 1991; 10: 1-34.
- 29Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med. 2001; 344(17): 1286-1292.
- 30Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005; 106(8): 2710-2715.
- 31Seigerman M, Cavallaro P, Itagaki S, et al. Incidence and outcomes of heparin-induced thrombocytopenia in patients undergoing cardiac surgery in North America: an analysis of the nationwide inpatient sample. J Cardiothorac Vasc Anesth. 2014; 28(1): 98-102.
- 32Chaudhry R, Wegner R, Zaki JF, et al. Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Vascular Surgery. J Cardiothorac Vasc Anesth. 2017; 31(5): 1751-1757.
- 33Tutwiler V, Madeeva D, Ahn HS, et al. Platelet transactivation by monocytes promotes thrombosis in heparin-induced thrombocytopenia. Blood. 2016; 127(4): 464-472.
- 34Warkentin TE. Clinical picture of heparin-induced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia. Thromb Haemost. 2016; 116(5): 813-822.
- 35Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad Med J. 2007; 83(983): 575-582.
- 36Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med. 1996; 101(5): 502-507.
- 37Warkentin TE, Greinacher A. Management of heparin-induced thrombocytopenia. Curr Opin Hematol. 2016; 23(5): 462-470.
- 38Cuker A, Gimotty PA, Crowther MA, Warkentin TE. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2012; 120(20): 4160-4167.
- 39Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018; 2(22): 3360-3392.
- 40Warkentin TE, Heddle NM. Laboratory diagnosis of immune heparin-induced thrombocytopenia. Curr Hematol Rep. 2003; 2(2): 148-157.
- 41Nagler M, Bachmann LM, ten Cate H, ten Cate-Hoek A. Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2016; 127(5): 546-557.
- 42Watson H, Davidson S, Keeling D, et al. Guidelines on the diagnosis and management of heparin-induced thrombocytopenia: second edition. Br J Haematol. 2012; 159(5): 528-540.
- 43Kang M, Alahmadi M, Sawh S, et al. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood. 2015; 125(6): 924-929.
- 44Warkentin TE, Greinacher A, Koster A. Bivalirudin. Thromb Haemost. 2008; 99(5): 830-839.
- 45Warkentin TE, Pai M, Linkins LA. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017; 130(9): 1104-1113.
- 46Goel R, Ness PM, Takemoto CM, et al. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015; 125(9): 1470-1476.
- 47Franchini M. Heparin-induced thrombocytopenia: an update. Thromb J. 2005; 3: 14.
- 48Warkentin TE, Anderson JA. How I treat patients with a history of heparin-induced thrombocytopenia. Blood. 2016; 128(3): 348-359.
- 49Patriquin CJ, Laroche V, Selby R, et al. Therapeutic Plasma Exchange in Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021; 385(9): 857-859.
- 50Bourguignon A, Arnold DM, Warkentin TE, et al. Adjunct Immune Globulin for Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021; 385(8): 720-728.
- 51Dabbiru VAS, Müller L, Schönborn L, Greinacher A. Vaccine-Induced Immune Thrombocytopenia and Thrombosis (VITT)-Insights from Clinical Cases, In Vitro Studies and Murine Models. J Clin Med. 2023; 12(19).
- 52Greinacher A, Warkentin TE. Thrombotic anti-PF4 immune disorders: HIT, VITT, and beyond. Hematology Am Soc Hematol Educ Program. 2023; 2023(1): 1-10.
- 53Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010; 376(9757): 2018-2031.
- 54Esoh K, Wonkam A. Evolutionary history of sickle-cell mutation: implications for global genetic medicine. Hum Mol Genet. 2021; 30(R1): R119-R128.
- 55Azbell RCG, Desai PC. Treatment dilemmas: strategies for priapism, chronic leg ulcer disease, and pulmonary hypertension in sickle cell disease. Hematology Am Soc Hematol Educ Program. 2021; 2021(1): 411-417.
- 56Kavanagh PL, Fasipe TA, Wun T. Sickle Cell Disease: A Review. JAMA. 2022; 328(1): 57-68.
- 57Monfort JB, Senet P. Leg Ulcers in Sickle-Cell Disease: Treatment Update. Adv Wound Care (New Rochelle). 2020; 9(6): 348-356.
- 58Altman IA, Kleinfelder RE, Quigley JG, et al. A treatment algorithm to identify therapeutic approaches for leg ulcers in patients with sickle cell disease. Int Wound J. 2016; 13(6): 1315-1324.
- 59Minniti CP, Eckman J, Sebastiani P, et al. Leg ulcers in sickle cell disease. Am J Hematol. 2010; 85(10): 831-833.
- 60Klingelhöller C, Schneider SW. Differential Diagnosis, Causes and Therapy of Leg Ulcers. Phlebologie. 2021; 51: 31-36.
- 61Ladizinski B, Bazakas A, Mistry N, et al. Sickle cell disease and leg ulcers. Adv Skin Wound Care. 2012; 25(9): 420-428.
- 62Grosse R, Lukacs Z, Cobos PN, et al. The Prevalence of Sickle Cell Disease and Its Implication for Newborn Screening in Germany (Hamburg Metropolitan Area). Pediatr Blood Cancer. 2016; 63(1): 168-170.
- 63Herrick JB. Peculiar elongated and sickle-shaped red blood corpuscles in a case of severe anemia. 1910. Yale J Biol Med. 2001; 74(3): 179-184.
- 64Minniti CP, Kato GJ. Critical Reviews: How we treat sickle cell patients with leg ulcers. Am J Hematol. 2016; 91(1): 22-30.
- 65Koshy M, Entsuah R, Koranda A, et al. Leg ulcers in patients with sickle cell disease. Blood. 1989; 74(4): 1403-1408.
- 66Senet P, Blas-Chatelain C, Levy P, et al. Factors predictive of leg-ulcer healing in sickle cell disease: a multicentre, prospective cohort study. Br J Dermatol. 2017; 177(1): 206-211.
- 67 Gesellschaft-für-pädiatrische-Onkologie-und-Hämatologie. AWMF-S2k-Leitlinie 025/016 „Sichelzellkrankheit“, 2. Auflage vom 2. Juli 2020. Available from: https://www.awmf.org/leitlinien/detail/ll/025-016.html. Published 2020 [Last accessed January 11, 2024].
- 68Minniti CP, Taylor JGT, Hildesheim M, et al. Laboratory and echocardiography markers in sickle cell patients with leg ulcers. Am J Hematol. 2011; 86(8): 705-708.
- 69Minniti CP, Gorbach AM, Xu D, et al. Topical sodium nitrite for chronic leg ulcers in patients with sickle cell anaemia: a phase 1 dose-finding safety and tolerability trial. Lancet Haematol. 2014; 1(3): e95-e103.
- 70Oliveira Paggiaro A, Fernandes de Carvalho V, Hencklain Fonseca GH, et al. Negative pressure therapy for complex wounds in patients with sickle-cell disease: a case study. Ostomy Wound Manage. 2010; 56(8): 62-67.
- 71Serjeant GR, Galloway RE, Gueri MC. Oral zinc sulphate in sickle-cell ulcers. Lancet. 1970; 2(7679): 891-892.
- 72Swe KM, Abas AB, Bhardwaj A, et al. Zinc supplements for treating thalassaemia and sickle cell disease. Cochrane Database Syst Rev. 2013; 2013(6):CD009415.
- 73Lionnet F, Bachmeyer C, Stankovic K, et al. Efficacy of the endothelin receptor blocker bosentan for refractory sickle cell leg ulcers. Br J Haematol. 2008; 142(6): 991-992.
- 74Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev. 2012; 12(12):CD001733.
- 75Frost ML, Treadwell P. Treatment of sickle cell leg ulcers with pentoxifylline. Int J Dermatol. 1990; 29(5): 375-376.
- 76Eckman JR. Leg ulcers in sickle cell disease. Hematol Oncol Clin North Am. 1996; 10(6): 1333-1344.
- 77Brouet JC, Clauvel JP, Danon F, et al. Biologic and clinical significance of cryoglobulins. A report of 86 cases. Am J Med. 1974; 57(5): 775-788.
- 78Neel A, Perrin F, Decaux O, et al. Long-term outcome of monoclonal (type 1) cryoglobulinemia. Am J Hematol. 2014; 89(2): 156-161.
- 79Terrier B, Karras A, Kahn JE, et al. The spectrum of type I cryoglobulinemia vasculitis: new insights based on 64 cases. Medicine (Baltimore). 2013; 92(2): 61-68.
- 80Sansonno D, Tucci FA, Ghebrehiwet B, et al. Role of the receptor for the globular domain of C1q protein in the pathogenesis of hepatitis C virus-related cryoglobulin vascular damage. J Immunol. 2009; 183(9): 6013-6020.
- 81Drerup C, Metze D, Ehrchen J, et al. Evidence for immunoglobulin-mediated vasculitis caused by monoclonal gammopathy in monoclonal gammopathy of unclear significance prompting oncologic treatment. JAAD Case Rep. 2019; 5(3): 288-291.
- 82Ghembaza A, Boleto G, Bommelaer M, et al. Prognosis and long-term outcomes in type I cryoglobulinemia: A multicenter study of 168 patients. Am J Hematol. 2023; 98(7): 1080-1086.
- 83Harel S, Mohr M, Jahn I, et al. Clinico-biological characteristics and treatment of type I monoclonal cryoglobulinaemia: a study of 64 cases. Br J Haematol. 2015; 168(5): 671-678.
- 84Sidana S, Rajkumar SV, Dispenzieri A, et al. Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia. Am J Hematol. 2017; 92(7): 668-673.
- 85Terrier B, Krastinova E, Marie I, et al. Management of noninfectious mixed cryoglobulinemia vasculitis: data from 242 cases included in the CryoVas survey. Blood. 2012; 119(25): 5996-6004.
- 86Khwaja J, Vos JMI, Pluimers TE, et al. Clinical and clonal characteristics of monoclonal immunoglobulin M-associated type I cryoglobulinaemia. Br J Haematol. 2024; 204(1): 177-185.
- 87Motyckova G, Murali M. Laboratory testing for cryoglobulins. Am J Hematol. 2011; 86(6): 500-502.
- 88Gammon B, Longmire M, DeClerck B. Intravascular crystal deposition: an early clue to the diagnosis of type 1 cryoglobulinemic vasculitis. Am J Dermatopathol. 2014; 36(9): 751-755.
- 89Kennedy C, Doyle R, Mayer N, Clarkson M. A case of malignancy-associated cryoglobulinemia. Case Rep Nephrol Urol. 2013; 3(1): 69-73.
- 90Terrier B, Cacoub P. Cryoglobulinemia vasculitis: an update. Curr Opin Rheumatol. 2013; 25(1): 10-18.
- 91Leypoldt LB, Ghandili S, Schneider SW, et al. Severe Cryoglobulinemic Vasculopathy and Underlying Monoclonal Gammopathy: The Importance of Identifying and Targeting the Underlying Plasma Cell Clone in Diagnosis and Treatment. Archives of Clinical and Biomedical Reserch. 2021; 5: 556-568.
- 92Hansen I, Ghandili S, Abeck F, et al. [Letaler Verlauf einer Kryoglobulinamie Typ I]. J Dtsch Dermatol Ges. 2023; 21(Suppl 2): 15-18.
- 93Guzman AK, Balagula Y. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment. Clin Dermatol. 2020; 38(6): 613-628.
- 94Grau RG. Drug-Induced Vasculitis: New Insights and a Changing Lineup of Suspects. Curr Rheumatol Rep. 2015; 17(12): 71.
- 95Merkel PA. Drug-induced vasculitis. Rheum Dis Clin North Am. 2001; 27(4): 849-862.
- 96Trusau A, Brit ML. Propylthiouracil-induced ANCA-negative cutaneous small vessel vasculitis. J Community Hosp Intern Med Perspect. 2018; 8(1): 35-37.
- 97Nakazawa D, Tomaru U, Suzuki A, et al. Abnormal conformation and impaired degradation of propylthiouracil-induced neutrophil extracellular traps: implications of disordered neutrophil extracellular traps in a rat model of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2012; 64(11): 3779-3787.
- 98Alotaibi A, Alsubaie M, Burmeister A, et al. Propylthiouracil-induced ANCA-associated vasculopathy. J Dtsch Dermatol Ges. 2022; 20(2): 223-226.
- 99Woller S, Sood A, Maclean AKW. Propylthiouracil-induced vasculitis. Proc (Bayl Univ Med Cent). 2023; 36(5): 647-649.
- 100Noh JY, Yasuda S, Sato S, et al. Clinical characteristics of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis caused by antithyroid drugs. J Clin Endocrinol Metab. 2009; 94(8): 2806-2811.
- 101Wall AE, Weaver SM, Litt JS, Rae L. Propylthiouracil-Associated Leukocytoclastic Necrotizing Cutaneous Vasculitis: A Case Report and Review of the Literature. J Burn Care Res. 2017; 38(3): e678-e685.
- 102Sun XJ, Li ZY, Chen M. Pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis. Rheumatol Immunol Res. 2023; 4(1): 11-21.
- 103Chen M, Gao Y, Guo XH, Zhao MH. Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis. Nat Rev Nephrol. 2012; 8(8): 476-483.
- 104Gao Y, Chen M, Ye H, et al. Long-term outcomes of patients with propylthiouracil-induced anti-neutrophil cytoplasmic auto-antibody-associated vasculitis. Rheumatology (Oxford). 2008; 47(10): 1515-1520.
- 105Morais P, Baudrier T, Mota A, et al. Antineutrophil cytoplasmic antibody (ANCA)-positive cutaneous leukocytoclastic vasculitis induced by propylthiouracil confirmed by positive patch test: a case report and review of the literature. Cutan Ocul Toxicol. 2011; 30(2): 147-153.
- 106Stein JC, Hernandez S, Hebig A. Necrotizing vasculitis as a complication of propylthiouracil. West J Emerg Med. 2008; 9(4): 212-215.
- 107Gao Y, Zhao MH, Guo XH, et al. The prevalence and target antigens of antithyroid drugs induced antineutrophil cytoplasmic antibodies (ANCA) in Chinese patients with hyperthyroidism. Endocr Res. 2004; 30(2): 205-213.
- 108Tu YL, Tsai YC, Huang JL, Yao TC. Occult pulmonary hemorrhage as a rare presentation of propylthiouracil-induced vasculitis. Pediatrics. 2011; 127(1): e245-249.
- 109Ahmed K, Rao S, Simha V. Antineutrophil cytoplasmic antibody-positive vasculitis in a patient with graves disease: cross-reaction between propylthiouracil and methimazole. Endocr Pract. 2010; 16(3): 449-451.
- 110Dartevel A, Chaigne B, Moachon L, et al. Levamisole-induced vasculopathy: A systematic review. Semin Arthritis Rheum. 2019; 48(5): 921-926.
- 111Marquez J, Aguirre L, Munoz C, et al. Cocaine-Levamisole-Induced Vasculitis/Vasculopathy Syndrome. Curr Rheumatol Rep. 2017; 19(6): 36.
- 112Sundararaj KCS, Chapman AB, Sprenger CJ, et al. Levamisole-induced cutaneous vasculitis. Clin Exp Dermatol. 2020; 45(7): 935-937.
- 113Eiden C, Diot C, Mathieu O, et al. Levamisole-adulterated cocaine: what about in European countries? J Psychoactive Drugs. 2014; 46(5): 389-392.
- 114McGrath MM, Isakova T, Rennke HG, et al. Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease. Clin J Am Soc Nephrol. 2011; 6(12): 2799-2805.
- 115Arora NP, Jain T, Bhanot R, Natesan SK. Levamisole-induced leukocytoclastic vasculitis and neutropenia in a patient with cocaine use: an extensive case with necrosis of skin, soft tissue, and cartilage. Addict Sci Clin Pract. 2012; 7(1): 19.
- 116Veronese FV, Dode RS, Friderichs M, et al. Cocaine/levamisole-induced systemic vasculitis with retiform purpura and pauci-immune glomerulonephritis. Braz J Med Biol Res. 2016; 49(5):e5244.
- 117Lood C, Hughes GC. Neutrophil extracellular traps as a potential source of autoantigen in cocaine-associated autoimmunity. Rheumatology (Oxford). 2017; 56(4): 638-643.
- 118Trimarchi M, Bussi M, Sinico RA, et al. Cocaine-induced midline destructive lesions - an autoimmune disease? Autoimmun Rev. 2013; 12(4): 496-500.
- 119Ruffer N, Krusche M, Holl-Ulrich K, et al. [Cocaine-induced vasculitis and mimics of vasculitis]. Z Rheumatol. 2023; 82(7): 606-614.
- 120Subesinghe S, van Leuven S, Yalakki L, et al. Cocaine and ANCA associated vasculitis-like syndromes - A case series. Autoimmun Rev. 2018; 17(1): 73-77.
- 121Trehy ML, Brown DJ, Woodruff JT, et al. Determination of levamisole in urine by gas chromatography-mass spectrometry. J Anal Toxicol. 2011; 35(8): 545-550.
- 122Gross RL, Brucker J, Bahce-Altuntas A, et al. A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Clin Rheumatol. 2011; 30(10): 1385-1392.
- 123Roberts JA, Chevez-Barrios P. Levamisole-Induced Vasculitis: A Characteristic Cutaneous Vasculitis Associated With Levamisole-Adulterated Cocaine. Arch Pathol Lab Med. 2015; 139(8): 1058-1061.
- 124Fred HL. Skin Necrosis Induced by Coumarin Congeners. Tex Heart Inst J. 2017; 44(4): 233-236.
- 125Alsahli MM, Shadid A, Al-Modayfer A, et al. Cutaneous Necrosis Over the Nose and Lower Limbs Induced by Acenocoumarol: A Case Report and Literature Review. Cureus. 2023; 15(3):e36960.
- 126Nazarian RM, Van Cott EM, Zembowicz A, Duncan LM. Warfarin-induced skin necrosis. J Am Acad Dermatol. 2009; 61(2): 325-332.
- 127Nalbandian RM, Mader IJ, Barrett JL, et al. Petechiae, Ecchymoses, and Necrosis of Skin Induced by Coumarin Congeners: Rare, Occasionally Lethal Complication of Anticoagulant Therapy. JAMA. 1965; 192: 603-608.
- 128Tai CY, Ierardi R, Alexander JB. A case of warfarin skin necrosis despite enoxaparin anticoagulation in a patient with protein S deficiency. Ann Vasc Surg. 2004; 18(2): 237-242.
- 129Valdivielso M, Longo I, Lecona M, Lazaro P. Cutaneous necrosis induced by acenocoumarol. J Eur Acad Dermatol Venereol. 2004; 18(2): 211-215.
- 130Chan YC, Valenti D, Mansfield AO, Stansby G. Warfarin induced skin necrosis. Br J Surg. 2000; 87(3): 266-272.
- 131DeFranzo AJ, Marasco P, Argenta LC. Warfarin-induced necrosis of the skin. Ann Plast Surg. 1995; 34(2): 203-208.
- 132Schreiner S, Alotaibi A, Menz A, et al. Ein interessanter Fall: Rezidivierendes Ulcus zentrofazial. J Dtsch Dermatol Ges. 2021; 19(Suppl 1): 5-7.
