What substance is associated with this presentation?

September 12, 2018

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.

Use of which substance is most likely to be associated with this presentation?

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Image credit: @daba


Answer: Cocaine

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.

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