title: Is Levamisole-Induced Vasculitis a Relegated Diagnostic Possibility? A Case Report and Review of Literature.
abstract: BACKGROUND
  Levamisole, a veterinary anti-helminthic, is a common adulterant in cocaine. Levamisole-induced vasculopathy (LIV) is a relatively new entity, and is being increasingly recognized since it was first reported in 2010. Although cutaneous findings, agranulocytosis, and positive antineutrophil cytoplasmic antibodies (ANCA) are characteristic, the full clinical picture and appropriate management remain unclear.
  
  
  METHODS
  A 38-year-old woman presented with malaise and a pruritic, painful rash on all extremities, right ankle pain, and effusion and necrosis of the right 2nd and 3rd finger tips. After extensive work-up, we determined that she had LIV.
  
  
  CONCLUSIONS
  Arthritis-dermatitis syndrome in cocaine users should raise suspicion for LIV. Although some features are characteristic, the full clinical spectrum is yet to be described. Management is supportive.
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Soumya
authors.initials: S
authors.lastname: Patnaik
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Percy
authors.initials: P
authors.lastname: Balderia
authors.affiliation: Department of Medicine, Division of Infectious Disease, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Vanchhawng
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Peyman
authors.initials: P
authors.lastname: Markazi
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Wykretowicz
authors.affiliation: Department of Medicine, Division of Infectious Disease, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Perloff
mesh_terms: D000328:Adult; D000969:Antinematodal Agents / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D014657:Vasculitis / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D000969:Antinematodal Agents; D007978:Levamisole