title: Levamisole-induced vasculopathy:  a report of 2 cases and a novel histopathologic finding.
abstract: Although cocaine-induced pseudovasculitis and urticarial vasculitis have been reported in the past, levamisole-induced vasculopathy with ecchymosis and necrosis, termed here LIVEN, has only recently been described in association with cocaine use. Levamisole, a veterinary antihelminthic agent used previously as an immunomodulating agent, is present as a "cutting agent" in approximately two-thirds of the cocaine currently entering the United States. Levamisole is believed to potentiate the effects of cocaine and may also be used as a "signature" for tracing its market distribution. Herein, we report 2 cases of LIVEN in patients with histories of chronic cocaine use. In both the cases, a temporal association with neutropenia preceding the eruption was noted. A novel histopathologic finding present only in the second case was the presence of extensive interstitial and perivascular neovascularization. Our 2 cases reaffirm that neutropenia may precede the cutaneous eruption of LIVEN. Case 2 extends the spectrum of histopathologic findings to include the novel phenomenon of neovascularization-hitherto unreported in this entity.
authors.affiliation: Department of Dermatology, Boston University School of Medicine,609 Albany Street, Boston, MA 02118, USA.
authors.forename: Reza S
authors.initials: RS
authors.lastname: Jacob
authors.forename: Claudine Yap
authors.initials: CY
authors.lastname: Silva
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Powers
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Schieke
authors.forename: Gary
authors.initials: G
authors.lastname: Mendese
authors.forename: Rufus W
authors.initials: RW
authors.lastname: Burlingame
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Miller
authors.forename: Deon
authors.initials: D
authors.lastname: Wolpowitz
authors.forename: Emmy
authors.initials: E
authors.lastname: Graber
authors.forename: Meera
authors.initials: M
authors.lastname: Mahalingam
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D003042:Cocaine / Q000009:adverse effects* / Q000737:chemistry; D019970:Cocaine-Related Disorders / Q000150:complications; D004340:Drug Contamination; D004438:Ecchymosis / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D007978:Levamisole; D003042:Cocaine