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The percentage of cocaine adulterated with levamisole is steadily increasing in the United States. In susceptible persons, this combination of drugs leads to a clinical syndrome that can include leukopenia and cutaneous manifestations. Many patients also demonstrate positive autoimmune markers. Biopsies of skin lesions often reveal a thrombotic pattern, leukocytoclastic vasculitis, or both. We report 2 cases of this clinical phenomenon, one of which was severe enough to require skin grafting. It is important for clinicians be aware of this emerging public health threat.


Gerald W Morris, Bryan C Mason, Rachael Harris Sprunger, Holly Hake Harris, Luke A White, Dale A Patterson. Levamisole-adulterated cocaine: a case series. Journal of the American Board of Family Medicine : JABFM. 2012 Jul-Aug;25(4):531-5

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PMID: 22773722

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