Suspected Infective Endocarditis Finally Turned Out to Be Levamisole-Induced Vasculitis: A Case Report and Review of Literature

Abstract

Levamisole is an immune-modulating drug with serious side effects including neutropenia and necrotizing vasculitis. Cocaine is often adulterated with levamisole to potentiate its action. Levamisole-induced vasculitis seen in cocaine users presents diagnostic challenges since it is rare and mimics clinical features of other diseases. It typically presents with a purpuric rash that can involve the nose, ears, cheeks, and extremities. Laboratory findings include leukopenia, lymphocytosis and anti-neutrophil cytoplasmic antibodies (ANCA). No therapies other than supportive care have been found to be effective. Early recognition is critical for supportive therapy and avoidance of potentially harmful therapies like corticosteroids. We report a case of levamisole-induced vasculitis which was suspected to have infective endocarditis at admission. J Med Cases. 2016;7(7):270-273 doi: http://dx.doi.org/10.14740/jmc2538w