title: Necrosis of ears after use of cocaine probably adulterated with levamisole.
abstract: OBJECTIVE
  Levamisole is an anthelminthic drug with immunomodulatory properties that has been found to be an adulterant of cocaine in the last 2 years. It was present at least in 70% of tainted cocaine in the U.S.A. in 2009.
  
  
  METHODS
  We present the case of a 40-year-old patient with a history of weekend cocaine use who consulted for bilateral necrotic lesions in the ears that had appeared 3 days after the last use.
  
  
  RESULTS
  Levamisole causes a typical clinical picture characterized by bilateral necrosis of the ears, positive perinuclear antineutrophil cytoplasmic antibodies and laboratory findings of antiphospholipid syndrome, such as anticardiolipin antibodies and/or lupus anticoagulant.
  
  
  CONCLUSIONS
  Dermatologists should be aware of this new entity, which is likely to be more and more frequent due to the increasing use of cocaine. Here we describe a clinical case that is likely to be secondary to levamisole-tainted cocaine and review the literature.
authors.affiliation: Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain. inma_delahera@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: de la Hera
authors.forename: V
authors.initials: V
authors.lastname: Sanz
authors.forename: D
authors.initials: D
authors.lastname: Cullen
authors.forename: R
authors.initials: R
authors.lastname: Chico
authors.forename: G
authors.initials: G
authors.lastname: Petiti
authors.forename: M
authors.initials: M
authors.lastname: Villar
authors.forename: M
authors.initials: M
authors.lastname: Burgués
authors.forename: J
authors.initials: J
authors.lastname: Sanz
authors.forename: M
authors.initials: M
authors.lastname: Castellanos
authors.forename: O
authors.initials: O
authors.lastname: Zarco
authors.forename: P L
authors.initials: PL
authors.lastname: Ortiz
authors.forename: J L
authors.initials: JL
authors.lastname: Rodríguez-Peralto
authors.forename: F
authors.initials: F
authors.lastname: Vanaclocha
mesh_terms: D000328:Adult; D000871:Anthelmintics / Q000633:toxicity*; D019970:Cocaine-Related Disorders; D004340:Drug Contamination; D054644:Ear Auricle / Q000473:pathology*; D006801:Humans; D007978:Levamisole / Q000633:toxicity*; D008297:Male; D009336:Necrosis / Q000139:chemically induced
chemical_list: D000871:Anthelmintics; D007978:Levamisole