Cocaine/levamisole-induced vasculopathy

Abstract

A 45-year-old woman was admitted to the hospital with non-inflammatory retiform purpura of the extremities and face that developed shortly after using cocaine. Her laboratory evaluation revealed neutropenia, thrombocytopenia, phospholipid antibodies, antinuclear antibodies, and perinuclear antineutrophil cytoplasmic antibodies. A skin biopsy showed a thrombotic vasculopathy. Based on her constellation of findings, a diagnosis of cocaine/levamisole-induced vasculopathy was rendered. Historically, levamisole has been utilized for its anthelmintic and immunomodulatory properties; it is now widely used as a cocaine adulterant. The classic tetrad of the cocaine/levamisole-induced vasculopathy syndrome includes non-inflammatory retiform purpura involving the cheeks and/or earlobes, neutropenia, ANCA positivity, and evidence of recent cocaine use. The differential diagnosis, clinical approach, etiology, and management of this entity are discussed.

Keywords

• levamisole
• cocaine
• vasculopathy
• purpura
• neutropenia
• neutrophil cytoplasmic antibodies