Table I.

Patient characteristics

Patient	Medical history	Presentation, Tx, and outcome	Laboratory results	Urine toxicology	Skin biopsy specimen results
A 46 y  Caucasian  Female	Substance abuse	1-mo History of purpura  and necrosis on bilateral  ears, cheeks, and upper  and lower extremities Tx: steroids Initial improvement,  lost to f/u	Neutropenia: no P-ANCA >2500 --Positive MPO and PR3 Anticardiolipin IgM positive ANA, hepatitis, HIV negative Cryoglobulins negative	Not performed on  admission, but previously  positive for cocaine  and THC	Small vessel vasculitis with  intravascular thrombi
B 57 y  African American  Female	Substance abuse,  depression, anxiety,  hypertension, and  recurrent  Staphylococcus  aureus skin infections	1-wk History of purpura  and necrosis of bilateral  ears and cheeks Tx: IV antibiotics,  gradual improvement;  neutropenia treated  with filgrastim Relapse 6 mo later with  same presentation,  laboratory results, and  positive cocaine urine  test result	Neutropenia: yes P-ANCA >2500 --Positive MPO and PR3  Anticardiolipin IgM positive  ANA, SSA, SSB, dsDNA, C3,  C4 negative Hepatitis, HIV negative Cryoglobulins negative	Positive for cocaine	Intravascular thrombi
C 46 y  Hispanic  Female	Substance abuse,  hepatitis C,  hypothyroidism	Bilateral ear necrosis,  diffuse retiform purpura  with necrosis on neck,  trunk, and extremities Tx: IV methylprednisolone Gradual improvement  initially, lost to f/u	Neutropenia: yes P-ANCA 640, C-ANCA 1280 Anticardiolipin IgM positive ANA, SSA, SSB, dsDNA, C3,  C4 negative Cryoglobulins negative	Positive for cocaine  and opiates	Multiple intravascular  thrombi
D 22 y  Hispanic  Female	Substance abuse	3-wk History of purpura  and necrosis of bilateral  ears, cheeks, nasal tip,  buttocks, and thighs Tx: IV methylprednisolone Skin and neutropenia  improved rapidly	Neutropenia: yes P-ANCA 2560 --Negative MPO and PR3 Anticardiolipin IgM positive ANA, SSA, SSB, dsDNA negative HIV, hepatitis negative Cryoglobulins negative	Positive for cocaine  and opiates	Small vessel vasculitis with  multiple intravascular  thrombi
E 37 y  Hispanic  Male	Substance abuse	Tender bilateral ear  purpura and necrosis,  diffuse retiform purpura  on trunk and extremities Tx: supportive Rapid improvement of skin	Neutropenia: no P-ANCA 640 CRP 16.2 mg/L, ESR 41 mm/h,  D-dimer elevated at 3260,  LDH 390 IU/L, PTT 37.7 sec,  INR 1.3 ANA 1:40 HIV negative	Positive for cocaine	Leukocytoclastic vasculitis IF: vascular deposits of IgM,  with weak staining for C3,  IgG, and IgA;vascular and  perivascular staining for  fibrin
F 50 y  African American  Male	Substance abuse	Altered mental status;3-wk  history of tender purpura  and necrosis of bilateral  ears; purpura and bullae  over trunk and extremities Tx: antibiotics Mental status and skin  improved rapidly	Neutropenia: no P-ANCA 640 CRP 5.67 mg/L, ESR 32 mm/hr,  D-dimer elevated at 548, PTT  39.6 sec ANA 1:40 HIV negative	Positive for cocaine	Leukocytoclastic vasculitis  and focal panniculitis  IF: vascular deposits of IgM,  IgA, C3, and weakly IgG;  interstitial and vascular  positive staining for fibrin

ANA, Antinuclear antibody; C-ANCA, cytoplasmic antineutrophil cytoplasmic antibody; CRP, c-reactive protein; dsDNA, double-stranded DNA; ESR, erythrocyte sedimentation rate; f/u, follow-up; IF, immunofluorescence; INR, international normalized ratio; IV, intravenous; LDH, lactate dehydrogenase; MPO, antimyeloperoxidase antibodies; P-ANCA, perinuclear antineutrophil cytoplasmic antibody; PR3, anti-proteinase-3 antibodies; PTT, partial thromboplastin time; SSA, Sjogren Syndrome A (anti-Ro); SSB, Sjogren Syndrome B (anti-La); THC, tetrahydrocannabinol (marijuana component); Tx, treatment.