Retiform Purpura Caused by the Use of Cocaine Adulterated with Levamisole

The document reports a case of a 52-year-old woman who developed retiform purpura, a skin condition with reticulated and necrotic lesions, after using cocaine likely adulterated with levamisole. Levamisole, an anthelmintic drug previously used in humans but now only in veterinary medicine, has been associated with this condition when used as a cocaine adulterant. The woman presented with painful skin lesions, arthralgia, and hematological abnormalities including leukopenia and neutropenia. A skin biopsy confirmed thrombotic vasculopathy. After being treated with low-dose oral prednisone, her hematological symptoms resolved within 5 days, and the skin lesions healed after one month without sequelae. The case emphasizes the need for awareness of levamisole-adulterated cocaine as a potential cause of retiform purpura and associated systemic symptoms.