Cocaine has been implicated in many rheumatologic conditions. Recognition of these syndromes is important for appropriate diagnosis and management because they often are confused and misdiagnosis results. The principal effects of cocaine are seen in the CNS and the corticomesolimbic dopamine reward pathway. Whether cocaine itself or in combination with host proteins is immunogenic and whether such a phenomenon has clinical relevance is unclear. Levamisole was recently found to contaminate up to 70% of cocaine samples; it has been postulated to cause various cutaneous lesions. Cocaine-induced midline destructive lesions have been associated with cocaine. Cocaine may have deleterious effects on the cardiovascular system. Management strategies include making the diagnosis, gaining knowledge of the disorders that cocaine can mimic, and testing for cocaine and levamisole contaminant. (J Musculoskel Med. 2012;29:34-40)
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