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.