The Ulcerative Effects of Levamisole-Induced Vasculitis

Levamisole-induced vasculitis is an autoimmune vasculitis that is most commonly associated with the use of levamisole-adulterated cocaine. We present a case of a 35-year-old undomiciled woman who was admitted to the inpatient psychiatric unit for drug detoxification and evaluation of bilateral lower extremity ulcerations. Her clinical presentation, along with a history of cocaine use, raised suspicion for levamisole-associated vasculitis. Symptomatic resolution and cutaneous healing in these cases are typically observed within 2-14 months following sustained abstinence from cocaine. This case highlights the growing concern for the lack of routine screening of drug adulterants such as levamisole in patients with known polysubstance abuse. To improve outcomes and reduce morbidity and mortality in this patient population, routine laboratory evaluation and diagnostic workup for adulterating agents should be incorporated into standard protocols. Additionally, comprehensive treatment plans should include nutritional support, wound care, and individualized addiction management strategies. Early recognition and targeted intervention are essential for optimizing care and promoting recovery in patients with substance use-related complications.