Levamisole-contaminated cocaine: an emergent cause of vasculitis and skin necrosis.
The prevalence of cocaine adulterated with levamisole-induced vasculitis is increasing and physicians should be aware of this unique entity. There have been many reports of cutaneous vasculitis syndrome caused by cocaine which is contaminated with levamisole. Levamisole was used as an antihelminth drug and later was rescinded from use in humans due to adverse effects. Through this paper, we will report a 39-year-old crack cocaine user who presented with purpuric rash and skin necrosis of his ear lobes. Levamisole-induced vasculitis syndrome was suspected. A urine toxicology screen was positive for cocaine, opiates, and marijuana. Blood work revealed positive titres of ANA and p-ANCA, as well as anti-cardiolipin antibody. Biopsy taken from the left ear showed focal acute inflammation, chronic inflammation with thrombus formation, and extravasated blood cells. Treatment was primarily supportive with wound care.
Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Osama
0000-0001-5730-0088
O
Souied
Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Hassan
0000-0002-7515-7948
H
Baydoun
Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Zahraa
0000-0002-8048-8282
Z
Ghandour
Department of Infectious Diseases, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Neville
N
Mobarakai