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-
1
Macfarlane DG, Bacon PA: Levamisole-induced vasculitis due to circulating immune complexes. Br Med J 1: 407, 1978.
-
2
Roberts JA, Chévez-Barrios P: Levamisole-induced vasculitis: a characteristic cutaneous vasculitis associated with levamisole-adulterated cocaine. Arch Pathol Lab Med 139: 1058, 2015.
-
3
Abdul-Karim R, Ryan C, Rangel C, et al: Levamisole-induced vasculitis. Proc (Bayl Univ Med Cent) 26: 163, 2013.
-
4
Goldstein G: Mode of action of levamisole. J Rheumatol Suppl 4: 143, 1978.
-
5
Larocque A, Hoffman RS: Levamisole in cocaine: unexpected news from an old acquaintance. Clin Toxicol 50: 231, 2012.
-
6
Lung D, Lynch K, Agrawal S, et al: Adult female with rash on lower extremities. Ann Emerg Med 57: 307, 2011.
-
7
Patnaik S, Balderia P, Vanchhawng L, et al: Is levamisole-induced vasculitis a relegated diagnostic possibility? a case report and review of literature. Am J Case Rep 16: 658, 2015.
-
8
The Erowid Crew: Cocaine adulterated with levamisole on the rise: status as of September 2009. Available at: http://www.erowid.org/chemicals/cocaine/cocaine_article2.shtml. Published October 1, 2009. Accessed February 25, 2017.
-
9
Shawwa K, Alraiyes AH, Eisa N, et al: Cocaine-induced leg ulceration. BMJ Case Rep[doi:].
-
10
Lee KC, Ladizinski B, Federman, DG: Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge. Mayo Clin Proc 87: 581, 2012.
-
11
Graf J, Lynch K, Yeh CL, et al: Purpura, cutaneous necrosis, and antineutrophil cytoplasmic antibodies associated with levamisole-adulterated cocaine. Arthritis Rheum 63: 3998, 2011.
-
12
Arora NP, Jain, T, Bhanot R, et al: Levamisole-induced leukocytoclastic vasculitis and neutropenia in a patient with cocaine use: an extensive case with necrosis of skin, soft tissue, and cartilage. Addict Sci Clin Pract 7: 19, 2012.
-
13
Belfonte CD, Shanmugam VK, Kieffer N, et al: Levamisole-induced occlusive necrotising vasculitis in cocaine abusers: an unusual cause of skin necrosis and neutropenia. Int Wound J 10: 590, 2013.
-
14
El-Ghobarey AF, Mavrikakis M, Morgan I, et al: Delayed healing of varicose ulcer with levamisole. Br Med J 1: 616, 1977.
-
15
Mendivil JM, Jolley D, Walters J, et al: Group B and F beta streptococcus necrotizing infection-surgical challenges with a deep central plantar space abscess: a diabetic limb salvage case report. JAPMA 106: 218, 2016.
Levamisole-Induced Vasculitis in the Lower Extremities: A Case Report
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Background:
Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations.
Results:
Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing.
Conclusions:
Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions.
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