Levamisole was initially discovered as an anthelmintic agent in the 1960s. It was subsequently found to have immunomodulatory effects and was used in the treatment of nephritic syndrome, colon cancer, and rheumatoid arthritis. Recently, attention has been focused on the use of levamisole as a cutting agent in cocaine after reports of agranulocytosis associated with the drug. In addition to agranulocytosis, levamisole has been linked to cutaneous vasculitis.1,2 We report herein 2 cases of cutaneous necrosis associated with cocaine use that are most likely from levamisole contamination.
Farhat EK, Muirhead TT, Chaffins ML, Douglass MC. Levamisole-Induced Cutaneous Necrosis Mimicking Coagulopathy. Arch Dermatol. 2010;146(11):1320-1321. doi:10.1001/archdermatol.2010.335