Cocaine-induced Vasculitis: Uncommon Manifestations in the Lower Extremities - A Case Report

Levamisole-induced vasculitis is a recognized dermatopathologic phenomenon frequently observed in individuals engaged in illicit substance use, particularly cocaine. Levimasole's structural resemblance to cocaine leads to its utilization as a cutting or bulking agent, creating an illusion of unaltered purity. While this vasculitis typically manifests in cartilaginous areas such as the ears and nose, it can also occur, though less commonly, in the lower extremities. At the time of writing, our case is the 3^rd case of levamisole induced vasculitis to affect the lower extremities. The primary therapeutic approach involves discontinuing the use of the implicated agent, as repeated exposure to levamisole tends to exacerbate skin lesions with subsequent use. In this report, we present the case of a 30-year-old female with a history of cocaine use, who presented with extensive bilateral chronic leg wounds affecting her ambulation. Histopathological analysis of the skin biopsy confirmed signs of levamisole-induced vasculitis. Our objective is to raise awareness among both the public and healthcare providers, emphasizing the consideration of cocaine-induced vasculitis in patients presenting with chronic non-healing wounds, even in less common anatomical regions. Encouraging substance use cessation is crucial in the management of such cases.