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

Arch Dermatol Res. 2021 Nov 22:1-9. doi: 10.1007/s00403-021-02303-1. Online ahead of print.

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.

PMID:34807290 | PMC:PMC8607060 | DOI:10.1007/s00403-021-02303-1