Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole

Leukocytoclastic vasculitis is a cutaneous, small-vessel vasculitis. In 50% of cases the aetiology is idiopathic but it can be linked to drugs, infections, autoimmune disorders and various types of cancer. Levamisole is used as an adulterant in cocaine and heroin and has been associated with the development of leukocytoclastic vasculitis. We describe an atypical presentation of a patient with levamisole-induced leukocytoclastic vasculitis who presented with diffuse skin abscesses and a purpuric rash of the upper and lower limbs. LEARNING POINTS: In patients with intravenous drug consumption and a clinical presentation of leukocytoclastic vasculitis, it is important to consider levamisole as a possible contributing factor. Negative screening for MPO-ANCA and PR3-ANCA antibodies does not exclude levamisole-induced leukocytoclastic vasculitis. Diagnostic criteria for leukocytoclastic vasculitis induced by levamisole have not yet been established.