What substance is associated with this presentation?
Figure 1 Quiz of the Week
A 45-year-old female presents with painful lesions on her lower limbs and ears. She is a smoker, and has a history of recreational drug use. Purpuric, necrotic lesions are noted on both lower extremities, in addition to tender purpura on both ears. A biopsy is performed which demonstrates leukocytoclastic vasculitis.
A common adulterant added to cocaine is a veterinary anthelminthic medication called levamisole. The use of levamisole-contaminated cocaine is associated with distinctive tender purpuric lesions which typically involve the ears, but they can also develop on the cheeks, nose, trunk, and extremities.