Abstract

VILLA-SALDARRIAGA, María P et al. Cocaine-levamisole induced vasculitis with cutaneous, joint and abdominal manifestations: case report. Revista médica Risaralda [online]. 2022, vol.28, n.2, pp.177-186.  Epub Dec 29, 2022. ISSN 0122-0667.  https://doi.org/10.22517/25395203.24982.

Levamisole is an antiparasitic agent for veterinary use. Currently it is used to increase the volume and potency of cocaine. Levamisole and cocaine combined result in the septum nasal perforation and small-vessel vasculitis in the ears and nasal cartilage. These findings are known as cocaine levamisole-induced vasculitis and can progress to necrosis and even skin ulceration, which is associated with agranulocytosis, arthralgia, and glomerulonephritis. This article describes the case of a patient with a history of substance abuse in whom palpable purpuric lesions were found in the upper and lower limbs, trunk, and ears. A clinical condition suggestive of vasculitis induced by cocaine-levamisole was considered, given the history of substance consumption. In the diagnostic process, entities such as Anti-neutrophil Cytoplasmic Antibodiy (ANCA) vasculitis and cryoglobulinemia, among other possible conditions, were ruled out. Steroid treatment was carried out, to which the patient had an adequate response, but then symptoms recurred, particularly abdominal, which were associated with vasculitis. Additional management with cyclophosphamide and new steroid pulses were provided, and with those symptom control was achieved. In this case report highlights the diagnostic and clinical exercises in cocaine levamisole vasculitis and is suggested the consideration of abdominal symptoms as a possible component of the vasculitis flare.

Keywords : Substance use disorder; vasculitis; cocaine; levamisole.

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