![]() Careful consultation with rheumatology to consider autoimmune diseases is recommended. Multiple autoimmune serological markers can be positive including anti-dsDNA, ANCAs, platelet factor IV antibody, lupus anticoagulant, Russell viper venom time, elevated PTT, and anticardiolipin IgM. Levamisole testing of serum or urine is difficult and unreliable. The combination of neutropenia in a patient with purpura of the ears and a urine toxicology screen positive for cocaine should suggest levamisole-induced vasculitis. Neutropenia is a common laboratory finding. Purpura is difficult to detect in extremely dark skin. In dark-skinned individuals, the rash may present with deep red to brown or purple macules and papules. Progression of the purpura to necrosis and crusting eschars is common before resolution. Very early, the purpura may be preceded by erythematous macules. Retiform or stellate purpura on the trunk and extremities that can progress to bullae. Somewhat tender purpuric macules and papules on the helix of the ear or the cheeks. Since neutropenia is a common presenting sign of this toxicity, bacterial or fungal infections may be presenting features of levamisole toxicity. Other cases have had absolutely no preceding medical history. Several published cases have had concurrent or preceding medical histories that involve both chronic and acute infections as well as signs of chronic autoimmune disease. Some analyses have revealed up to 10% contamination of individual cocaine products.īecause levamisole is difficult to test for and because other treatable causes of vasculitis may be present, levamisole-induced toxicity is a diagnosis of exclusion. ![]() ![]() The cocaine can be either smoked as crack cocaine or snorted. Toxicity induced by levamisole seems to affect all ages and both genders equally depending on cocaine use. The CDC estimates that approximately 70% of cocaine in the United States may be contaminated with levamisole. Concomitant symptoms of arthralgias, fever, and mouth pain have been reported. ![]()
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