Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Rheumatology
Volume 2016, Article ID 2685267, 4 pages
http://dx.doi.org/10.1155/2016/2685267
Case Report

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

1Internal Medicine Department, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY 10305, USA
2Pathology Department, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY 10305, USA
3Rheumatology Department, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY 10305, USA

Received 29 April 2016; Accepted 20 June 2016

Academic Editor: Mehmet Soy

Copyright © 2016 Lara El Khoury et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.