Levamisole can cause a cutaneous vasculitis. It may be encountered as an adulterant in cocaine.

Levamisole is an antihelminthic drug with several uses but it is rarely used in developed countries.


Presentation: painful nonpruritic purpuric skin rash


Distribution: extremities, trunk, head and neck (nose, ears, cheeks)


Pathology: leukocytoclastic vasculitis or thrombotic vasculopathy


Other complications:

(1) leukopenia or agranulocytosis

(2) lupus anticoagulant

(3) autoantibodies (p-ANCA, c-ANCA, antinuclear antibodies)


The patient is typically positive for cocaine metabolites.

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