Pemphigus Vegetans Associated with Intranasal Cocaine Abuse
Bibliographic record
Abstract
Background: Pemphigus vegetans is a rare variant of pemphigus vulgaris, comprising 1 to 2% of all pemphigus cases. Exposures to oral agents such as captopril and penicillamine and, less commonly, physical or chemical factors have been implicated in the development of pemphigus. Methods: We report a 42-year-old white male with a 12-month history of hypertrophic, vegetative plaques affecting primarily his external nares and upper lips. The patient had a history of alcoholism and intermittent drug abuse, primarily intranasal cocaine, since his youth. He had been using cocaine heavily three to four times/week for 1 month prior to and 1 month following the onset of the eruption but has since ceased use. His clinical features and histopathologic findings were consistent with a diagnosis of pemphigus vegetans. Treatment with high-dose prednisone (80 mg/d) and mycophenolate mofetil (1.5 g/d) resulted in resolution of the lesions after 18 months. Results and Conclusions: To our knowledge, this is the second report proposing an association between intranasal cocaine use and the pemphigus family of disorders. Although the relationship between illicit drug use and the development of pemphigus is unclear, we postulate that intranasal cocaine abuse is operative in our patient's disease. Herein we discuss drug and other external precipitants of pemphigus and review previous case reports of pemphigus associated with illicit drugs. Renseignements de base: Le pemphigus végétant est une variante rare du pemphigus vulgaire, comptant pour 1 à 2 % de tous les cas de pemphigus. Un rapprochement a été établi entre l'exposition à des agents oraux tels que le captopril et la pénicillamine et, moins couramment, à des facteurs physiques ou chimiques, dans le développement du pemphigus. Méthodes: Nous exposons le cas d'un homme de race blanche âgé de 42 ans ayant des antécédents de plaques végétatives hypertrophiques pendant 12 mois, touchant principalement ses narines externes et ses lèvres supérieures. Le patient avait des antécédents d'alcoolisme et de consommation intermittente de drogues, principalement de la cocaïne prise par voie intranasale, depuis sa jeunesse. Il avait consommé de façon excessive de la cocaïne trois à quatre fois par semaine pendant le mois qui avait précédé et avait suivi l'apparition de l'éruption, mais il a depuis ce temps cessé d'en user. Ses caractéristiques cliniques et les résultats histopathologiques correspondaient à un diagnostic de pemphigus végétant. Le traitement consistant en la prise de fortes doses de prednisone (80 mg/j) et de mycophenolate mofetil (1,5 g/j) a entraîné la résorption des lésions après 18 mois. Résultats et conclusions: À notre connaissance, ce rapport est le deuxième qui propose l'existence d'une association entre la consommation de cocaïne par voie intranasale et le groupe de maladies pemphigus. Bien que la relation entre la consommation de drogues illicites et le développement du pemphigus ne soit pas claire, nous postulons que la consommation de cocaïne par voie intranasale a une incidence sur la maladie de notre patient. Nous discutons aux présentes des drogues et d'autres déclencheurs externes du pemphigus et nous examinons les rapports de cas antérieurs de pemphigus associé à la consommation de drogues illicites.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".