What is in the cocaine? The vessels never lie—cocaine-induced vasculitis

A 45-year-old female with a past medical history significant for type II diabetes mellitus, hypertension, vasculitis of unknown type with no family history of autoimmune vasculitis, untreated hepatitis C, bipolar disorder, and cocaine abuse presented with purpuric skin lesions on the nose, bilateral ears, and bilateral upper and lower extremities. Two days prior to presentation, the patient had been in pain secondary to arthritis, so she used cocaine from a friend for self-management. Overnight following the exposure to cocaine, she developed skin lesions. She reported similar skin lesions following cocaine self-administration in the past. Regarding her history of vasculitis, she has had recurrent episodes of vasculitis of unknown etiology for the past 3 years treated with corticosteroids (dose and duration unknown), which she stopped 1 month ago due to running out of medication and not renewing her indigent care. The episodes have been associated temporally with cocaine use.