Case Presentation: A 51-year-old male with a history of recent pneumonia and cocaine use (most recently 4 weeks prior) presented to the emergency department for shortness of breath. Exam demonstrated decreased left sided breath sounds with x-ray confirming left lower lobe consolidation and effusion.  Labs revealed neutropenia and a negative urine drug screen.  Neutropenia was [...]

Case Presentation: A 54-year old man with active cocaine use and untreated hepatitis C presented with fever and rash. He last smoked cocaine 4 days prior to admission. In the next several days, tender enlarging rashes appeared on the left arm and legs. On admission he was febrile (100.5 F) with HR of 101 and [...]

Case Presentation: A 61-year-old African-American male with a history of hepatitis C virus, syphilis and substance abuse history presented with a 1-day history of painful, blue discoloration of toes, ears, and nose associated with exquisitely tender, hyperpigmented and edematous distal upper and lower extremities. The patient’s urine drug screen was positive for cocaine. The location [...]

Case Presentation: A 47-year-old African American woman with poly-substance abuse presented with a facial rash, bilateral hand joint pain and painful ulcers to the lower extremities for one week. Physical examination revealed violaceous tender skin lesions on the bilateral helices and right naris. There was mild erythema to the malar area involving the naso-labial folds. [...]

Case Presentation: 29 y.o. female with a history of autoimmune hepatitis presented with worsening lower extremities ulceration. The onset of rash was four months ago during which she visited dermatology clinic. Vitals signs were within normal limits, physical examination was consistent with large deep necrotic painful ulceration with violaceous erythema, retiform purpura on bilateral lower [...]

Case Presentation: A 40-year-old Caucasian male with a past medical history of polysubstance abuse, with a preference for cocaine, presented to the emergency department complaining of right groin pain. He was diagnosed with purulent cellulitis and broad spectrum intravenous antibiotics were initiated. Initial blood work found low WBC (3.7 x 103/mcL), with a low neutrophilic [...]

Case Presentation: The prevalence of cocaine use is growing worldwide. Damaging effects of cocaine on the cardiovascular, neurologic, and pulmonary systems are well-established. In recent years, evidence has emerged for cocaine-induced damage to other organs, such as the liver and kidney. This is a case of end-organ damage from regular cocaine use. A 65-year-old man [...]

Case Presentation: A 67 year- old man presented with three weeks of progressively worsening painful ulcers in bilateral lower extremities and fingers. The lesions started as numerous erythematous lesions on his legs and fingers five months ago that subsequently turned into inflamed blisters and ultimately evolved into painful crusted ulcers. He was treated with antibiotics and [...]

Case Presentation: Levamisole is an anti-parasitic drug used in the veterinary setting. It is a frequent cocaine contaminant found in about 60-70% of samples in the United States (US) [1]. Cocaine contaminated with this substance is linked to antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis [2]. As in the last decade, cocaine use worldwide has been [...]

Case Presentation: A 48-year-old woman with history of anxiety, depression, chronic pain, and polysubstance abuse was brought to the hospital for unusual behavior. She was hospitalized one month prior for behavior change and diagnosed with substance induced psychosis. She returned to the hospital after two weeks of recurrent bizarre behavior at home including wandering disrobed, [...]