Levamisole-Induced Occlusive Necrotizing Vasculitis of the Ears After Use of Cocaine Contaminated with Levamisole
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Based on the best available data, approximately 2.1 million Americans use illicit cocaine each month; for the last several months, 30% of that cocaine has been “cut” with a veterinary pharmaceutical, levamisole. Levamisole can cause agranulocytosis, leaving patients susceptible to fulminate and opportunistic infections and also can cause a debilitating cutaneous necrotizing vasculitis. In this manuscript, we describe a case and provide an image of levamisole-induced necrotizing vasculitis of the ears.
KeywordsLevamisole Vasculitis Cocaine Necrotizing
Given the prevalence of levamisole found in cocaine in the Denver area, the patient's low WBC, and historical evidence of levamisole-induced occlusive necrotizing vasculitis, a levamisole level was sent. Qualitative urine levamisole was positive. The patient was discharged with a diagnosis of levamisole-induced occlusive necrotizing vasculitis. Levamisole was originally developed as an antihelminthic agent and is approved as adjuvant chemotherapy, for the treatment of colon cancer. Levamisole-induced occlusive necrotizing vasculitis is an uncommon side-effect of levamisole. Reports of ear lobe and cutaneous necrosis have been reported in the literature after levamisole was used to treat various cancers, nephrotic syndrome, and rheumatologic disorders [1, 2]. Treatment is primarily supportive with cessation of the offending agent; however, steriods have been used in some cases with success.