Levamisole toxicity mimicking autoimmune disease

Erythema elevatum diutinum-like vasculitis secondary to cocaine adulterated with levamisole

“…However, individuals with LIV are commonly misdiagnosed with connective tissue disorders, based on multiple positive autoimmune antibodies. 5 The improvement of our patient's systemic and cutaneous findings with cocaine avoidance is diagnostic of her symptoms being secondary to adulterated cocaine. This case emphasizes that not all LIV presents with retiform purpura, and that dermatologists should have a low threshold of suspicion to perform toxicology screens in patients with unusual or treatment-resistant vasculitis.…”

“…Our patient had been diagnosed previously with systemic lupus erythematosus, which can be associated with EED. However, individuals with LIV are commonly misdiagnosed with connective tissue disorders, based on multiple positive autoimmune antibodies . The improvement of our patient's systemic and cutaneous findings with cocaine avoidance is diagnostic of her symptoms being secondary to adulterated cocaine.…”

Bilateral tunnel vision as the first presenting sign of levamisole-induced vasculitis

“…Levamisole is a synthetic imidazothiazole derivative which was originally marketed as an anthelmintic agent but was also found to have major immunomodulatory properties (1). It induced interferon synthesis and synergized the effect of steroids and other immunosuppressants (2).…”

Reversible High-Grade Atrioventricular Block Associated With Cocaine Use

“…adulterated cocaine has been associated with a vasculitis similar to that seen in our patient, which commonly involves the ears and extremities and is frequently associated with positive ANCA findings. 6 There is no known treatment apart from cessation of cocaine use. To our knowledge, the association between levamisole and AV block has not previously been reported in humans.…”