Cutaneous Necrotizing Vasculitis and Leukopenia in a Cocaine User: Is Levamisole the Culprit?

Lara El Khoury,Mark Goldstein,Richard Felix,Nabil Zeineddine

doi:10.1155/2016/2685267

Lara El Khoury, Mark Goldstein + Show 2 more

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https://doi.org/10.1155/2016/2685267

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Abstract

Levamisole is an antihelminthic drug banned by the US Food and Drug Administration (FDA) in 2000 because of its dangerous side effects. Over the past few years, it has been identified as an adulterant in cocaine and reported to cause cutaneous vasculitis in cocaine users. The health burden of levamisole is serious since it is estimated that over 5 million Americans use cocaine and that 70% of the cocaine used in the USA contains levamisole. In this paper we report the case of a 23-year-old female cocaine user that presented with purpuric rash and skin necrosis, found to have positive c-ANCA and anti-proteinase 3 antibodies. Her skin biopsy showed fibroconnective tissue with signs of necrosis, acute and chronic inflammation, and thrombus formation. She was diagnosed with levamisole-induced vasculitis and successfully treated with withdrawal of cocaine use and local wound care.

Highlights

IntroductionLevamisole is a veterinary antihelminthic drug that was initially approved for the treatment of several conditions including certain malignancies and rheumatoid arthritis [1, 2]
Levamisole is a veterinary antihelminthic drug that was initially approved for the treatment of several conditions including certain malignancies and rheumatoid arthritis [1, 2].In 2000, the US Food and Drug Administration (FDA) banned the use of levamisole in the United States (US) because of dangerous side effects such as agranulocytosis and skin necrosis [3, 4].Over the past few years, levamisole has been identified as an adulterant in cocaine, used to add weight and volume to the drug
We describe a case of a 25-year-old female patient, cocaine user, presenting with painful dark discoloration of lower extremities

Summary

Introduction

Levamisole is a veterinary antihelminthic drug that was initially approved for the treatment of several conditions including certain malignancies and rheumatoid arthritis [1, 2]. In 2000, the US Food and Drug Administration (FDA) banned the use of levamisole in the United States (US) because of dangerous side effects such as agranulocytosis and skin necrosis [3, 4]. Over the past few years, levamisole has been identified as an adulterant in cocaine, used to add weight and volume to the drug. Since 2010, numerous reports have emerged describing cutaneous vasculitis in cocaine users. We describe a case of a 25-year-old female patient, cocaine user, presenting with painful dark discoloration of lower extremities

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