Levamisole

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Background

  • Veterinary antihelminthic agent used as adulterant to cocaine
  • Increases cocaine bulk and enhances effects of cocaine

Clinical Manifestations

  • Can cause agranulocytosis, vasculopathy, dermatologic lesions, renal injury, and leukoencephalopathy

Vasculitis

  • Characteristic stellate lesions with erythematous borders and a necrotic centre, which frequently occur on ears and cheeks
  • Concurrent agranulocytosis, positive pANCA, cANCA, anti-cardiolipin, ANA, or anti-dsDNA, and ATN