- Initially marketed as antihelminthixc drug and immunomodulator. Was used to treat cancers, and different autoimmune diseases.
- Was withdrawn from market in 1999 due to side effects (agranulocytosis and vasculitis).
Levamisole as an adulterant in cocaine
- Metabolite of levamisole can inhibit NE reuptake, therefore prolonging cocaine effect.
Levamisole induced vasculopathy
- Pathognomonic lesion is purpura bilaterally at the ears (helices), but can spread to facial areas (eg cheeks) or involve upper/lower extremities.
– Not many involve ears. Possibly because ears have lower temperature that immune deposits may settle there.
- Have a latency period for up to 5 years
- As levamisole can lead to agaranulocytosis, a CBC screen can also help in diagnosis.
- Basically clinical
- Interesting auto-antibodies: ANCA antibodies can be found in levamisole-induced vasculopathy
– pANCA can be found in 100% of the patients, cANCA in 50% of the patients.
– mean latency of 24 months for development of these antibodies
- The histopathologic findings of cocaine-levamisole cutaneous vasculopathy syndrome range from leukocytoclastic and thrombotic vasculitis to vascular occlusive disease without true vasculitis
- Treatment with topical steroids is controversial.
- The most important is DISCONTINUATION of cocaine. The lesion will resolve in weeks.
- In severe cases, may need abx cover for suspected superinfection (before the culture results come back)
– Debridement with skin grafting maybe needed in more extensive lesions.
- Huy Tran, MD, PhD,* Debbie Tan, MD,* and Thomas P. Marnejon, DO. Cutaneous Vasculopathy Associated with Levamisole-Adulterated Cocaine. Clin Med Res. 2013 Feb; 11(1): 26–30
- Raghad Abdul-Karim, MD,corresponding author Caitriona Ryan, MD, Christina Rangel, and Michael Emmett, MD. Levamisole-induced vasculitis. Proc (Bayl Univ Med Cent). 2013 Apr; 26(2): 163–165
- Mark B. Ellis, DPM, and William D. Fishco, DPM, FACFAS. Treating Vasculitis Arising From Levamisole-Contaminated Cocaine. Podiatry Today, Aug 2014; 27(8)