Levamisole is an anthelminthic agent used mainly by veterinarians that is now commonly used as an adulterant in cocaine. Numerous case reports have connected levamisole with vasculitis and neutropenia. Our case focuses on a patient who used weekly cocaine contaminated with levamisole and developed necrosis of the skin in her lower extremities, abdomen, and lower back. To our knowledge, this is also the only case of levamisoleinduced vasculitis with leukocytosis, as neutropenia appears to be the typical finding.
We present a 30 year old female with history of hypothyroidism and alcohol abuse who presented to the hospital with complaints of ecchymoses on bilateral thighs associated with burning and hypersensitivity to touch and a 3 day history of jaundice. The patient also noted 3-week duration of generalized weakness and dizziness, while also noting 8 weeks of heavy vaginal bleeding. The patient used weekly cocaine, the last use was 4 days prior to admission, and consistently drank 40 ounces of malt liquor per day.