Levamisole tainted cocaine :An emerging health issue

### Learning Point for Clinicians Clinicians should suspect levamisole contamination in suspected drug abusers with very low absolute neutrophil count and neutropenia. It should be suspected early as chemical detection will only last 2–4 days. A 52-year-old male presents with complaints of a rash and pain in his perineal area for 4 days. The rash first appeared in his upper right thigh and was purpuric with a central black discoloration. He also complained of general malaise, fever of 103°F and diarrhea for 4 days. His past history includes chronic hepatitis C, alcoholism, liver cirrhosis and substance abuse. Laboratory studies revealed leukopenia (400 per mm3) with an absolute neutrophil count (ANC) of zero. A peripheral blood smear was also taken (Figure 1). Figure 1. Peripheral blood smear showing absence of neutrophils. Differential diagnosis at …