Is Levamisole-Induced Vasculitis a Relegated Diagnostic Possibility? A Case Report and Review of Literature

Patient: Female, 38 Final Diagnosis: Levamisole induced vasculitis Symptoms: Skin and joint Medication: — Clinical Procedure: None Specialty: Toxicology OBJECTIVE: Unusual clinical course BACKGROUND: Levamisole, a veterinary anti-helminthic, is a common adulterant in cocaine. Levamisole-induced vasculopathy (LIV) is a relatively new entity, and is being increasingly recognized since it was first reported in 2010. Although cutaneous findings, agranulocytosis, and positive antineutrophil cytoplasmic antibodies (ANCA) are characteristic, the full clinical picture and appropriate management remain unclear. CASE REPORT: A 38-year-old woman presented with malaise and a pruritic, painful rash on all extremities, right ankle pain, and effusion and necrosis of the right 2(nd) and 3(rd) finger tips. After extensive work-up, we determined that she had LIV. CONCLUSIONS: Arthritis-dermatitis syndrome in cocaine users should raise suspicion for LIV. Although some features are characteristic, the full clinical spectrum is yet to be described. Management is supportive.