p-ANCA-Associated Vasculitis Caused by Levamisole-Adulterated Cocaine: A Case Report

Abstract

A rare case of a patient with an unusual skin rash after using cocaine is presented. A clinical diagnosis of levamisole-induced vasculitis was made based on initial presentation of purpuric skin lesions involving the ears and positive cocaine on urine toxicology screening. The diagnosis was confirmed after laboratory findings of neutropenia, positive serum levamisole, and a histopathologic test of the skin lesions. The pathophysiology of this condition is discussed. Treatment with methylprednisolone and prednisone led to the resolution of the neutropenia and complete recovery of the skin lesions. With the growing use of levamisole-tainted cocaine, clinicians should be aware of the symptoms of vasculitis and neutropenia induced by this combination of drugs to avoid unnecessary tests and delayed diagnosis.

Cocaine-Induced Intermittent Purpuric Lesions of the Auricle: An Increasing Entity

“…Levamisole-adulterated cocaine induced vasculitis is a condition with increasing prevalence in the last decade due to its illegal use as a cutting agent [1,[4][5][6]. Cocaine is the illicit drug most frequently reported in the emergency department of the United States of America.…”

“…Cocaine is the illicit drug most frequently reported in the emergency department of the United States of America. It is believed that the percentage of levamisole adulterated cocaine has risen to approximately 82% in the USA and Europe [3,4,7]. Because of its physical properties it blends easily with cocaine.…”

“…Studies have suggested that the enhancing of stimulating, addictive and euphoric properties of cocaine is due to its effect on dopamine release [3][4][5]. Negative testing does not rule out the presence of levamisole or its causative role in the signs of this type of vasculitis, due to its short half life as happens without patient, who has negative laboratory findings [4,8,9].…”

Cocaine-induced ecchymotic rash

“…Treatment is mainly supportive, but emollients and steroids 4 have been reported to alleviate the symptoms. Surgical debridement is rarely needed unless skin necrosis is extensive.…”

Levamisole-adulterated cocaine: a case of retiform purpura, cutaneous necrosis and neutropenia

“…Since 2005, complications from snorting and or inhaling cocaine contaminated with levamisole have been drastically increasing throughout the world 1. Currently, the US Drug Enforcement Agency estimates that levamisole is present in at least 80% of all cocaine in North America 2. Furthermore, increasing levels are being detected in Europe and Asia.…”