Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole

Alberto Barbotti; Alina Cristiana Gheorghiu; Tanja Fusi-Schmidhauser; Lorenzo Grazioli-Gauthier

doi:10.12890/2022_003468

Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole

Eur J Case Rep Intern Med. 2022 Jul 25;9(7):003468. doi: 10.12890/2022_003468. eCollection 2022.

Authors

Alberto Barbotti¹, Alina Cristiana Gheorghiu¹, Tanja Fusi-Schmidhauser¹, Lorenzo Grazioli-Gauthier¹

Affiliation

¹ Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland.

Abstract

Leukocytoclastic vasculitis is a cutaneous, small-vessel vasculitis. In 50% of cases the aetiology is idiopathic but it can be linked to drugs, infections, autoimmune disorders and various types of cancer. Levamisole is used as an adulterant in cocaine and heroin and has been associated with the development of leukocytoclastic vasculitis. We describe an atypical presentation of a patient with levamisole-induced leukocytoclastic vasculitis who presented with diffuse skin abscesses and a purpuric rash of the upper and lower limbs.

Learning points: In patients with intravenous drug consumption and a clinical presentation of leukocytoclastic vasculitis, it is important to consider levamisole as a possible contributing factor.Negative screening for MPO-ANCA and PR3-ANCA antibodies does not exclude levamisole-induced leukocytoclastic vasculitis.Diagnostic criteria for leukocytoclastic vasculitis induced by levamisole have not yet been established.

Keywords: Leukocytoclastic vasculitis; cocaine; heroin; levamisole.