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Vasculitis, Levimasole, Autoimmune, Necrosis
Levamisole-induced vasculitis is characterized by a painful, purpuric rash in a retiform or stellate pattern with or without central necrosis that commonly involves the trunk, extremities, digits, distal nose, cheeks, and ear helices. This clinical syndrome is associated with the use of levamisole-adultered cocaine. Histologic findings for levamisole-induced vasculitis are not disease specific but may include leukocytoclastic vasculitis, microvascular thrombosis, and panniculitis. Laboratory findings of levamisole-induced toxicity include agranulocytosis, neutropenia, hepatotoxicity, glomerulonephritis, pulmonary hemorrhage, and positive p-ANCA, c-ANCA tests, ANA, or lupus anticoagulant. The differential diagnosis for levamisole-induced vasculitis includes leukocytoclastic vasculitis, drug reaction, cryoglobulinemia, idiopathic thrombocytopenic purpura, granulomatosis with polyangiitis, Churg-Strauss syndrome, and polyarteritis nodosa. Levamisole-induced vasculitis typically resolves spontaneously with cessation of cocaine use however; recurrence is common following re-exposure.
2. Lee K, Ladizinski B, Federman D. Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge. Mayo Clin Proc. 2012;87(6):581-586.
3. Abdul-Karim R, Ryan C, Rangel C, Emmett M. Levamisole-induced vasculitis. Proc (Bayl Univ Med Cent). 2013;26(2):163-165.
4. Jin Q, Kant S, Alhariri J, Geetha D. Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis. J Community Hosp Intern Med Perspect. 2018;8(6):339-344.
5. Cocaine Adulterated with Levamisole on the Rise. EROWID;2009 Available at: https://www.erowid.org/chemicals/cocaine/cocaine_article2.shtml. (Accessed 15 Mar 2019).
6. Chung C, Tumeh PC, Birnbaum R, et al. Characteristic purpura of the ears, vasculitis, and neutropenia--a potential public health epidemic associated with levamisole-adulterated cocaine. J Am Acad Dermatol. 2011;65(4):722-725.e722.
7. McGrath M, Isakova T, Rennke H, Mottola A, Laliberte K, Niles J. Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease. Clin J Am Soc Nephrol. 2011;6(12):2799-2805.
8. Wiesner O, Russell KA, Lee AS, Jenne DE, Trimarchi M, Gregorini G, Specks U. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase as a diagnostic marker for cocaine-induced midline destructive lesions but not autoimmune vasculitis. Arthritis Rheum. 2004 Sep;50(9):2954-65.
9. Pearson T, Bremmer M, Cohen J, Driscoll M. Vasculopathy related to cocaine adulterated with levamisole: A review of the literature. Dermatol Online J. 2012 Jul 15;18(7):1.
10. Hahn E, Bogoch II. Levamisole-induced Vasculitis in a Cocaine User. J Rheumatol. 2015;42(10):1924-1925.
11. Van der Veer T, Pennings E, Tervaert J, Korswagen L. Levamisole-contaminated cocaine: a hairy affair. BMJ Case Rep. 2015;2015.