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.
