Dramatic pictures: vasculitis caused by levamisole-contaminated cocaine

June 29, 2011, 11:20 am


A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Gross RL et al. Clin Rheumatol 2011 June 25. [Epub ahead of print]


In July 2009, the DEA reported that almost 70% of cocaine samples seized at U.S. borders contained levamisole, a veterinary antihelminthic agent. Although it is not clear why the drug is being added to cocaine, there are suggestions that it might increase dopamine levels and enhance cocaine’s euphoric effects. ┬áLevamisole-contaminated cocaine has been associated with cases of agranulocytosis.

This paper, from the Albert Einstein College of Medicine in New York, describes 4 cases of cutaneous vasculitis caused by levamisole-contaminated cocaine, and summarizes findings in these cases and 12 others previously reported in the medical literature. ┬áThis syndrome often presents with a retiform purpuric rash frequently involving the ears and cheeks, accompanied by leukopenia and positive anti-neutrophil cytoplasmic antibody (ANCA). Skin biopsy shows leukocytoclastic vasculitis and/or thrombosis. Although this syndrome is often treated with steroids, there is no evidence that this therapy is effective. The authors suggest that since the syndrome seems to be self-limited once exposure to cocaine and levamisole stops “clinicians should consider waiting before aggressive immunosuppressive therapy is initiated.”

The New England Journal of Medicine has posted a case presentation of this syndrome with dramatic photos of facial and earlobe lesions. (This short case report is a must-read — the pictures are unbelievable.)

Although a letter in the July issue of J Am Acad Dermatol claims to describe the first reported case of vasculitis after cocaine exposure in which there was a positive urine test for levamisole, the authors of the Einstein paper state that 2 cases previously reported in the literature were positive for the drug.

Related posts:

Scrotal gangrene after smoking crack

Unusual complication of cocaine abuse

Adulteration of street drugs

Adulterated drugs now and then: cocaine and jamaican ginger extract

Case reports: neutropenia associated with levamisole-adulterated cocaine

Why is the antihelmintic drug levamisole used to adulterate cocaine?

Cocaine adulterated with levamisole implicated in 21 cases of agranulocytosis




  1. SFtox Says:

    Pretty amazing how different the manifestation of the lesions can be, based on your genetics. Check out our case report in Annals of Emergency Medicine a few months ago… typical of what we see in California… rarely see facial/earlobe lesions.

  2. Leon Says:

    SF tox:

    Yes, your case report and illustrating photos were very interesting, and it is indeed curious that different populations seem to have distinct patterns of dermal reactions to levamisole.