There have been reports that vasculitis and retiform purpura induced by levamisole-tainted cocaine are also associated with the presence of circulating autoantibodies. It has been conjectured that it prolongs the effect of cocaine by increasing dopamine in euphoric centers of the brain. It is a white powder that easily blends with cocaine but is not simply filler as it acts on the same receptors. Levamisole has also been used illegally in recent years as a cutting agent in cocaine to enhance its euphoric properties among users. It is currently used mainly by veterinarians as an antiparasitic agent in animals. Levamisole is now banned by the FDA from use in humans in the United States. Levamisole suppresses white blood cell production and leads to neutropenia, agranulocytosis, and thrombotic vasculopathy which results in retiform purpura first observed in children treated with this drug for nephrotic syndrome. It also has immunomodulatory properties and was used in the treatment of colon and breast cancers, rheumatoid arthritis, and nephrotic syndrome. Levamisole is an anthelmintic medication that was originally used to treat worm infestation in human and animals. With the growing use of levamisole-tainted cocaine, clinicians should be aware of the symptoms of vasculitis and neutropenia induced by this combination of drugs to avoid unnecessary tests and delayed diagnosis. Treatment with methylprednisolone and prednisone led to the resolution of the neutropenia and complete recovery of the skin lesions. The pathophysiology of this condition is discussed. The diagnosis was confirmed after laboratory findings of neutropenia, positive serum levamisole, and a histopathologic test of the skin lesions. A clinical diagnosis of levamisole-induced vasculitis was made based on initial presentation of purpuric skin lesions involving the ears and positive cocaine on urine toxicology screening. A rare case of a patient with an unusual skin rash after using cocaine is presented.
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