Abstract
We report a case of cutaneous vasculopathy associated with the use of levamisole adulterated cocaine. This recently described clinical entity is characterized by a purpuric rash with a predilection for the ears, leukopenia and ANCA positivity. It is estimated that more than 70% of the current US cocaine supply is contaminated with levamisole. Levamisole is a widely available, inexpensive white powder used as a “cutting agent” in cocaine to expand volume and increase profits. It may also increase the euphoric and stimulatory effects of cocaine by increasing brain dopamine levels and producing amphetamine-like metabolites. Our patient exhibited a characteristic rash with involvement of the ears, leukopenia, and cocaine metabolites detected in serum and urine; the presence of levamisole was confirmed in the urine utilizing gas chromatography mass spectrometry. ANCA positivity was also present. Punch biopsy of the skin demonstrated vascular thrombosis and necrosis without true vasculitis. We review the literature reported cases of cocaine - levamisole cutaneous vasculopathy syndrome, highlight the salient immunologic abnormalities, and contrast the features of this entity with idiopathic systemic vasculitis.
- Received March 6, 2012.
- Revision received May 10, 2012.
- Accepted May 16, 2012.
