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March 2016

Otolaryngologic Manifestations of Levamisole-Induced Vasculitis

Author Affiliations
  • 1Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco.

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Otolaryngol Head Neck Surg. 2016;142(3):299-300. doi:10.1001/jamaoto.2015.3565

Levamisole is a synthetic imidazothizole derivative that was introduced in the 1970s for the treatment of rheumatalogic conditions and cancer owing to its immunomodulatory effects.1 Although withdrawn from the market in 2000 because of severe adverse reactions,2 levamisole is commonly found in cocaine. Adverse effects of levamisole include neutropenia, agranulocytosis, and vasculitis. Patients with levamisole-induced vasculitis (LIV) typically present with necrotic cutaneous lesions, secondary to microvascular thrombosis and small-vessel vasculitis, arthralgias, and malaise.3 Necrosis of the ears, malar eminence, and nose are among the most common findings of LIV. Despite increasing incidence, the full spectrum of otolaryngologic manifestations of LIV has yet to be delineated. Herein we report the first case, to our knowledge, of laryngeal involvement in LIV.

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