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Cocaine and Levamisole Induced Vasculitis.
Harpreet Gill1, Dylan Trinh2, Danyon J Anderson2
1Hospital Medicine, Medical College of Wisconsin, Wauwatosa, USA.
Cureus
|September 22, 2021
Summary
Levamisole-adulterated cocaine can cause anti-neutrophil cytoplasmic antibody (ANCA) vasculitis. Early diagnosis requires considering illicit drug use, as this rare condition is often underdiagnosed.
Area of Science:
- Rheumatology
- Toxicology
- Dermatology
Background:
- Levamisole adulteration in cocaine is an emerging cause of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.
- Despite increased awareness, diagnosis remains challenging due to rarity and underreporting of illicit substance use.
Observation:
- A 48-year-old male presented with acute bilateral ear pain and rash.
- A positive urinary drug screen raised suspicion for levamisole-adulterated cocaine-associated vasculitis.
- Punch biopsy revealed leukocytoclastic vasculitis and fibrin thrombi, supporting levamisole contamination.
Findings:
- The patient's presentation and biopsy results were consistent with levamisole-induced vasculitis.
- Confirmation of illicit substance use significantly altered the diagnostic and treatment approach.
Implications:
- This case underscores the importance of incorporating patient history, particularly illicit substance use, into the diagnostic workup for acute vasculitis.
- Clinicians should maintain a high index of suspicion for levamisole-induced vasculitis in patients presenting with compatible symptoms.
- Prompt identification of levamisole exposure can lead to timely intervention and improved patient outcomes.