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Cocaine Use and Levamisole-Induced Vasculitis: A Multiple Case Study.

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Levamisole-adulterated cocaine use can cause severe vasculitis with necrotic skin lesions. Prompt diagnosis and multidisciplinary care, including wound management and substance cessation, are crucial for patients with this condition.

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Area of Science:

  • Dermatology
  • Toxicology
  • Rheumatology

Background:

  • Levamisole, an immunomodulatory drug, was banned for human use due to severe side effects.
  • Levamisole-adulterated cocaine is linked to a dangerous syndrome with necrotizing purpuric rash and tissue destruction.
  • This article details the care of two women with levamisole-related vasculitis.

Observation:

  • A 46-year-old woman presented with joint pain, ear pain, swelling, and bleeding, diagnosed with vasculitis.
  • She experienced recurrences and exacerbations, ultimately diagnosed with levamisole-related vasculitis from cocaine use, leading to bilateral amputations.
  • A 50-year-old woman presented with lower extremity redness, swelling, blisters, and pustules that evolved into abscesses and lesions, worsening despite treatment.

Findings:

  • Levamisole-induced vasculitis presents with unexplained vasculitis-type lesions, especially with illicit substance use.
  • Wound care should follow moist wound healing principles with antimicrobial therapies and nonadherent dressings.
  • Multidisciplinary care focusing on cocaine cessation is essential.

Implications:

  • Wound, Ostomy, and Continence (WOC) nurses should consider levamisole-induced vasculitis in patients with unexplained lesions and a history of substance use.
  • The findings highlight the need for clinical guidelines for this condition.
  • A multidisciplinary approach is vital for managing patients with levamisole-related vasculitis and promoting recovery.