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.  Levamisole-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.  This 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.