When seen at follow-up visits at 1, 8, and 16 weeks, the patient's facial lesions had healed with minimal scaring. The facial lesions were treated with oral steroids and petroleum jelly ointment, and the patient was counseled to cease cocaine use. Results of urine toxicology testing was positive for cocaine metabolites, which was in concordance with the presumed diagnosis of LIV. Complete blood cell count findings were normal while results of antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) testing were positive. There were no mucosal stigmata to suggest burn injury. Endoscopy revealed normal hypopharyngeal and supraglottic mucosa, but bilateral ulcerative lesions of the true vocal folds with surrounding edema were detected ( Figure 2). The patient's voice was rough and breathy. Similar lesions were present on the thighs and hard palate ( Figure 1). Lesions were nonblanching centrally, with a rim of erythema.
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