SOURCE: Jeong HS, Layher H, Cao L, et al. Pyoderma gangrenosum (PG) associated with levamisole-adulterated cocaine: Clinical, serologic, and histopathologic findings in a cohort of patients. J Am Acad Dermatol 2016;74:892-898.

Clinicians should view photos of pyoderma gangrenosum. These images can be quite devastating and would likely add to the gravity of the information Jeong et al recently provided in a published report.

Pyoderma gangrenosum classically presents as a rapidly progressive, painful, suppurative cutaneous ulcer. The ulcer most commonly occurs on the legs but can appear anywhere on the body. Pyoderma gangrenosum is most commonly associated with malignancy and inflammatory disorders such as ulcerative colitis and rheumatoid arthritis.

In the United States, as much as 80% of cocaine is adulterated with levamisole, which is known to produce vasculitis. Jeong et al reported on eight consecutive patients presenting with pyoderma gangrenosum, each of whom had used cocaine. The biopsy pathology of cocaine/levamisole-induced pyoderma gangrenosum is indistinguishable from that associated with other disorders mentioned above. In addition to the other obvious concerns about cocaine use, add pyoderma gangrenosum to the list.