Levamisole-adulterated Cocaine Induced Vasculitis with Skin Ulcerations
A 40-year-old man with Hepatitis C and a history of cocaine abuse presented with multiple stages of painful rashes on his extremities and ears. On examination, the patient had several areas of purpuric macules and retiform purpura to his legs and ears ( and ), as well as large ulcerations with erythematous borders on bilateral lower extremities (). Laboratory studies revealed mild leukopenia (white blood cell 3.8 K/uL), positive anti-nuclear antibody (ANA), and negative cryoglobulins. Anti-myeloperoxidase antibodies (MPO-ANCA) and anti-proteinase-3 (PR3-ANCA) were also positive. Skin biopsy revealed dermal purpura and thrombi.