Retiform Purpura Caused by the Use of Cocaine Adulterated with Levamisole

January 2015 in “ Annals of Dermatology ”

José Luis Torregrosa Calatayud, Juan Garcías Ladaria, Blanca de Unamuno Bustos, Violeta Zaragozá Ninet, Víctor Alegre de Miquel

retiform purpura cocaine levamisole skin lesions arthralgia leukopenia neutropenia thrombotic vasculopathy prednisone skin condition painful skin lesions joint pain low white blood cell count low neutrophil count blood vessel disease steroid treatment

TLDR Cocaine possibly mixed with levamisole caused a woman's skin condition and blood issues, which improved with treatment.

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.

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