{"id":650,"date":"2020-10-26T19:19:08","date_gmt":"2020-10-26T23:19:08","guid":{"rendered":"http:\/\/wordpress.forensicpath.us\/?p=650"},"modified":"2023-11-24T21:36:48","modified_gmt":"2023-11-25T02:36:48","slug":"pathology-cases-dermpath-unknown","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2020\/10\/26\/pathology-cases-dermpath-unknown\/","title":{"rendered":"Pathology cases &#8212; levamisole vasculopathy skin lesion (was unknown)"},"content":{"rendered":"<p><strong>UPDATE:\u00a0<\/strong> I originally posted this as an unknown, but have become convinced that Dr. Stewart&#8217;s diagnosis of levamisole vasculopathy is correct.\u00a0 This decedent had similar lesions on his nose and cheeks, which is consistent with this diagnosis, and has a history of crack\/cocaine use.\u00a0 For nice reviews, see <a href=\"https:\/\/escholarship.org\/uc\/item\/6g18r9cv\">here<\/a> and <a href=\"https:\/\/www.researchgate.net\/profile\/Jules_Lipoff\/publication\/51250741_A_novel_cutaneous_vasculitis_syndrome_induced_by_levamisole-contaminated_cocaine\/links\/577e901208ae9485a43684b9.pdf\">here.<\/a><\/p>\n<p>It all goes to show how important individual experience is.\u00a0 I&#8217;ve never seen it (or at least didn&#8217;t notice it) in many years of experience.\u00a0\u00a0 One of my younger colleagues here looked and said it was a no-brainer &#8212; she saw it all the time where she trained.\u00a0 Doh.<\/p>\n<p>So, on with the pretty pictures:<\/p>\n<p>This is from a young middle-aged white male who died of a methamphetamine overdose.\u00a0 He suffered delirium and seizures prior to death, and had a number of superficial blunt trauma injuries.\u00a0 Examination of the scalp revealed this injury.\u00a0 While it is erythematous and has a vague appearance of scattered abrasion, the variegation and lack of obvious skin defects made it more likely a rash of some sort.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Here&#8217;s the gross picture:<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-scaled.jpeg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone size-large wp-image-651\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-1024x683.jpeg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-1024x683.jpeg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-300x200.jpeg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-768x512.jpeg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-1536x1024.jpeg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-2048x1366.jpeg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-1600x1067.jpeg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/8009449_small-272x182.jpeg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>Histologically, the keratinizing epithelium is intact, but there is a vasculitis with perivascular extravasation of erythrocytes:<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img decoding=\"async\" class=\"alignnone size-large wp-image-652\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1241.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img decoding=\"async\" class=\"alignnone size-large wp-image-653\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1240.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-654\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1238.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-655\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1237.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-656\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1236.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-657\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1235.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-658\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1232.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-659\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1230.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a> <a href=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-660\" src=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg\" alt=\"\" width=\"688\" height=\"459\" srcset=\"https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-1024x683.jpg 1024w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-300x200.jpg 300w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-768x512.jpg 768w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-1536x1024.jpg 1536w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-2048x1365.jpg 2048w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-1600x1067.jpg 1600w, https:\/\/wordpress.forensicpath.us\/wp-content\/uploads\/2020\/10\/DSC_1228.TIF.ppm_.small_.ppm_.color_corrected-272x182.jpg 272w\" sizes=\"(max-width: 688px) 100vw, 688px\" \/><\/a><\/p>\n<p><del>Any suggestions?<\/del><\/p>\n","protected":false},"excerpt":{"rendered":"<p>UPDATE:\u00a0 I originally posted this as an unknown, but have become convinced that Dr. Stewart&#8217;s diagnosis of levamisole vasculopathy is&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[109,60,1],"tags":[59,56,82,28,26,81,83],"class_list":["post-650","post","type-post","status-publish","format-standard","hentry","category-pathology-cases","category-photomicrographs","category-uncategorized","tag-autopsy","tag-histology","tag-levamisole","tag-pathology","tag-photomicrography","tag-skin","tag-vasculopathy"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/650","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=650"}],"version-history":[{"count":3,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/650\/revisions"}],"predecessor-version":[{"id":663,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/650\/revisions\/663"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=650"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=650"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=650"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}