Cocaine is a commonly used illicit drug that is associated with cocaine-induced midline destructive lesions (CIMDLs). It is increasingly adulterated with levamisole, which has been shown to cause levamisole-induced vasculitis (LIV), a systemic vasculitis with ENT repercussions. Approximately 976 000 people aged 16-59 used powder cocaine in 2018/19 in the UK. 1 Levamisole, initially marketed in 1971 as an anti-helminthic drug, was removed from the US market in 2000 due to adverse effects, such as vasculitis. 2,3 It adds weight to cocaine and may potentiate its euphoric effect. 4 Approximately 70% of seized cocaine contained levamisole, and the proportion of cocaine "cut" with levamisole is increasing globally. 4 Whilst the prevalence of CIMDL and LIV is small compared with overall cocaine use, clinical repercussions can be severe.

No abstract

No abstract

No abstract

No abstract