The Cocaine Trail: Levamisole-Induced Leukocytoclastic Vasculitis in a Cocaine User

ABSTRACT

Two million Americans use cocaine on a regular basis. Sixty-nine percent of cocaine in the United States is adulterated with levamisole, a veterinary antihelminthic drug. In 2008, the first cases of levamisole-induced agranulocytosis and vasculopathy associated with adulterated cocaine were reported in the southwestern United States. Since then, reports of levamisole-associated toxicity have become increasingly common. The authors present the case of a 47-year-old woman from Michigan with purpuric lesions likely secondary to levamisole-induced leukocytoclastic vasculitis.

Keywords:

• Cocaine adulterant
• leukocytoclastic vasculitis
• levamisole agranulocytosis, levamisole vasculopathy

Acknowledgments

The authors thank Dr. James Ramirez from the Department of Pathology at St. Joseph Mercy Hospital for providing the pathology slides and report. The authors also thank Dr. Rebecca Daniel for her assistance in the editorial process.