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25 September 2015 : Case report  USA

Is Levamisole-Induced Vasculitis a Relegated Diagnostic Possibility? A Case Report and Review of Literature

Unusual clinical course, Challenging differential diagnosis, Unexpected drug reaction, Clinical situation which can not be reproduced for ethical reasons

Soumya PatnaikEF, Percy BalderiaEF, Lisa VanchhawngEF, Peyman MarkaziE, Jedrzej WykretowiczE, Sarah PerloffE

DOI: 10.12659/AJCR.894537

Am J Case Rep 2015; 16:658-662

Abstract

BACKGROUND: Levamisole, a veterinary anti-helminthic, is a common adulterant in cocaine. Levamisole-induced vasculopathy (LIV) is a relatively new entity, and is being increasingly recognized since it was first reported in 2010. Although cutaneous findings, agranulocytosis, and positive antineutrophil cytoplasmic antibodies (ANCA) are characteristic, the full clinical picture and appropriate management remain unclear.

CASE REPORT: A 38-year-old woman presented with malaise and a pruritic, painful rash on all extremities, right ankle pain, and effusion and necrosis of the right 2nd and 3rd finger tips. After extensive work-up, we determined that she had LIV.

CONCLUSIONS: Arthritis-dermatitis syndrome in cocaine users should raise suspicion for LIV. Although some features are characteristic, the full clinical spectrum is yet to be described. Management is supportive.

Keywords: Antinematodal Agents - adverse effects, Diagnosis, Differential, Levamisole - adverse effects, Vasculitis - diagnosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923