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Abstract

Background: Levamisole, a common anthelmintic, is estimated to be present in up to 70% of the cocaine found in the United States. The exact mechanism of interaction between Levimasole and cocaine use is unknown. One such complication of ingestion of Levimasole contaminated cocaine is Levimasole Vasculitis. Here we report a case of the clinical presentation of Levimasole Vasculitis, and the emphasis on proper and thorough history taking when arriving at a diagnosis.

Case Presentation: Our case begins with a 71-year-old male with a history of COPD, hyperthyroidism, and polysubstance abuse who presented to the hospital with weakness, neck stiffness, chest pain, and chills. Patient initially was a poor historian and uncooperative, and stated his fatigue symptoms had begun around 7 days ago, and has progressively gotten worse. He stated that over the last 4 days he had noticed painful darkening lesions on his face and nose. Upon examination of the patient there were black and purple macules and patches on his chest, abdomen, and lower extremities. Additionally, there were dark purple skin discolorations on half of both of his ears, and purple and black necrotic skin at the tip of his nose. Initial differentials included meningitis, purpura fulminans, and autoimmune purpuras such as ITP and TTP, and immunological assays revealed an elevated P-ANCA with all other values within normal limits. Urine toxicological screening was positive for cocaine and benzodiazepines. Further interviews with the patient revealed he indulged in daily cocaine and alcohol use. However, he additionally disclosed that three of his other associates used the same cocaine he had ingested in the last week, and all three of them developed the same purpuric skin lesions on their face and extremities. Literature review done by the medical team revealed consistency of the lesions with Levamisole Vasculitis. The patient left AMA before any treatment regimen could be established.

Discussion & Conclusions: Levamisole-induced vasculitis is an uncommon result of cocaine usage, and can be puzzling to diagnose without proper background. Suspicion of Levamisole vasculitis should be high in any patient presenting with new onset purpuric rash and concomitant cocaine use. Careful consideration to the history and physical taking is a crucial component of the medical decisionmaking process. Here, we correlate careful and thorough interviewing with the discovery of a rare sequelae of cocaine usage.

Presentation Type

Poster

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Medical Student

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Case Report: Levamisole-Induced Vasculitis after Cocaine Ingestion

Background: Levamisole, a common anthelmintic, is estimated to be present in up to 70% of the cocaine found in the United States. The exact mechanism of interaction between Levimasole and cocaine use is unknown. One such complication of ingestion of Levimasole contaminated cocaine is Levimasole Vasculitis. Here we report a case of the clinical presentation of Levimasole Vasculitis, and the emphasis on proper and thorough history taking when arriving at a diagnosis.

Case Presentation: Our case begins with a 71-year-old male with a history of COPD, hyperthyroidism, and polysubstance abuse who presented to the hospital with weakness, neck stiffness, chest pain, and chills. Patient initially was a poor historian and uncooperative, and stated his fatigue symptoms had begun around 7 days ago, and has progressively gotten worse. He stated that over the last 4 days he had noticed painful darkening lesions on his face and nose. Upon examination of the patient there were black and purple macules and patches on his chest, abdomen, and lower extremities. Additionally, there were dark purple skin discolorations on half of both of his ears, and purple and black necrotic skin at the tip of his nose. Initial differentials included meningitis, purpura fulminans, and autoimmune purpuras such as ITP and TTP, and immunological assays revealed an elevated P-ANCA with all other values within normal limits. Urine toxicological screening was positive for cocaine and benzodiazepines. Further interviews with the patient revealed he indulged in daily cocaine and alcohol use. However, he additionally disclosed that three of his other associates used the same cocaine he had ingested in the last week, and all three of them developed the same purpuric skin lesions on their face and extremities. Literature review done by the medical team revealed consistency of the lesions with Levamisole Vasculitis. The patient left AMA before any treatment regimen could be established.

Discussion & Conclusions: Levamisole-induced vasculitis is an uncommon result of cocaine usage, and can be puzzling to diagnose without proper background. Suspicion of Levamisole vasculitis should be high in any patient presenting with new onset purpuric rash and concomitant cocaine use. Careful consideration to the history and physical taking is a crucial component of the medical decisionmaking process. Here, we correlate careful and thorough interviewing with the discovery of a rare sequelae of cocaine usage.

 

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