Antineutrophil cytoplasmic antibodies negative levamisole‐induced leukocytoclastic vasculitis: a presumed case and literature review

Abstract

Levamisole‐contaminated cocaine toxicity is a serious emerging public health concern, and providers should be aware of its presentation and management. Most cases of levamisole‐induced vasculitis/vasculopathy (LIV) are associated with high antineutrophil cytoplasmic antibodies (ANCA). We describe a unique case of a cocaine user who presented with an acute purpuric eruption and negative ANCA laboratory findings. A brief clinical overview of LIV, spanning from patient presentation to treatment, is provided. In addition, we present a summary of all cases of ANCA‐negative vasculitis identified via a PubMed literature review.

Leukocytoclastic Vasculitis Induced by Cocaine Adulterated with Levamisole

“…Microscopy usually shows mixed angiocentric cell infiltrates of neutrophils, eosinophils and lymphocytes. Histological analysis performed on our patient showed the leukocytoclastic type with abundant eosinophils [ 6 ] .…”

“…Laboratory findings often show neutropenia, leukopenia, and high levels of CRP [ 6 ] . In particular, most patients with levamisole-induced vasculitis are positive for MPO-ANCA (66–100%) or PR3-ANCA (50–66%) [ 7 , 8 ] , with both MPO-ANCA and PR3-ANCA positive in 43% of patients [ 8 ] .…”