Disseminated Necrotic Suppurative Ulcers as a Manifestation of Cocaine Abuse

INTRODUCTION/AIMS/BACKGROUND: Pyoderma gangrenosum is an immune-mediated illness that can be caused by several affections, such as inflammatory bowel disease, rheumatoid arthritis, and drug use. We present a rare case of pyoderma gangrenosum induced by levamisole-adulterated cocaine. There have been few cases of this disease reported in the world. Levamisole is an anthelmintic drug used to adulterate cocaine to boost its effect. It also has immune-modulating effects causing, among others, vasculitis and dermatological problems. MATERIALS AND METHODS: Clinical case of a 46-year-old man admitted to the hospital University Marqués de Valdecilla in Santander, Spain, in August 2022. We diagnosed pyoderma gangrenosum based on clinical, analytical, and histological parameters. RESULTS: We report a case of pyoderma gangrenosum induced by consumption of levamisole-adulterated cocaine. DISCUSSION: This patient suffered from a rare and extensive immune-mediated affection with characteristic primary lesions in the form of suppurative ulcers that responded to immunosuppressive treatment. Behind pyoderma gangrenosum there may be underlying conditions such as inflammatory bowel disease, or pyoderma gangrenosum may be secondary to identifiable causes such as cocaine use as in this patient. LEARNING POINTS: Pyoderma gangrenosum induced by levamisole-adulterated cocaine has the following features: History of cocaine use. Exaggerated skin injury occurring after minor trauma (pathergy). Characteristic histopathologic findings.