Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole
  • Alberto Barbotti
    Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
  • Alina Cristiana Gheorghiu
    Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
  • Tanja Fusi-Schmidhauser
    Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland
  • Lorenzo Grazioli-Gauthier
    Department of Internal Medicine, Ospedale Regionale di Lugano EOC, Lugano, Switzerland

Keywords

Leukocytoclastic vasculitis, cocaine, heroin, levamisole

Abstract

Leukocytoclastic vasculitis is a cutaneous, small-vessel vasculitis. In 50% of cases the aetiology is idiopathic but it can be linked to drugs, infections, autoimmune disorders and various types of cancer. Levamisole is used as an adulterant in cocaine and heroin and has been associated with the development of leukocytoclastic vasculitis. We describe an atypical presentation of a patient with levamisole-induced leukocytoclastic vasculitis who presented with diffuse skin abscesses and a purpuric rash of the upper and lower limbs.

VIEW THE ENTIRE ARTICLE

References

  • United Nations Office on Drugs and Crime. World Drug Report 2021. Available from: https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html.
  • Marquez J, Aguirre L, Muñoz C, Echeverri A, Restrepo M, Pinto LF. Cocaine-levamisole-induced vasculitis/vasculopathy syndrome. Curr Rheumatol Rep 2017;19(6):36.
  • Solomon N, Hayes J. Levamisole: a high performance cutting agent. Acad Forensic Pathol 2017;7(3):469–476. doi: 10.23907/2017.039.
  • Eiden C, Diot C, Mathieu O, Mallaret M, Peyriere H. Levamisole-adulterated cocaine: what about in European countries? J Psychoactive Drugs 2014;46(5):389–392. doi: 10.1080/02791072.2014.959215.
  • Casale EM, Casale JF. Identification of levamisole and lidocaine acetylation reaction impurities found in heroin exhibits. Microgram J 2011;8(1):16–23.
  • Kunzler D, Lagrimas L, Vo T, DeCrescenzo A, Kaltwasser K, Wilson J. Antineutrophil cytoplasmic antibodies negative levamisole-induced leukocytoclastic vasculitis: a presumed case and literature review. Int J Dermatol 2018;57(12):1411–1416.
  • Jin Q, Kant S, Alhariri J, Geetha D. Levamisole adulterated cocaine associated ANCA vasculitis: review of literature and update on pathogenesis. J Community Hosp Intern Med Perspect 2018;8(6):339–344. doi: 10.1080/20009666.2018.1536242.
  • Dartevel A, Chaigne B, Moachon L, Grenier F, Dupin N, Guillevin L, et al Levamisole-induced vasculopathy: a systematic review. Semin Arthritis Rheum 2019;48(5):921–926. doi: 10.1016/j.semarthrit.2018.07.010.

    • Views: 519
    HTML downloads: 574
    PDF downloads: 319

    Published: 2022-07-25
    Issue: 2022: Vol 9 No 7 (view)

    How to cite:
    1.
    Barbotti A, Gheorghiu AC, Fusi-Schmidhauser T, Grazioli-Gauthier L. Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole. EJCRIM 2022;9 doi:10.12890/2022_003468.

    Most read articles by the same author(s)