Cocaine-Induced Intermittent Purpuric Lesions of the Auricle: An Increasing Entity

A new challenge to the medical community is presented with Levamisole, an antihelmintic immunomodulatory agent, recently used in combination with cocaine to enhance its psychoactive effects. The prevalence of cocaine induced vasculopathy is increasing and physicians need to be aware of this emerging condition due to its serious possible complications. We report a case of intermittent purpuric skin lesions located in the auricles in a patient with regular cocaine consumption and a review of this distinctive clinical syndrome described linked to levamisole-adultered cocaine. A high index of suspicion should be kept in mind if this is considered a potential cause for purpuric intermittent lesions in cocaine abusers. To aid the diagnosis a punch biopsy associated with an extensive workup including immunologic testing is recommended. There are several clinical and laboratory findings that support a diagnosis of Levamisole induced vasculitis, including ANCA positivity, specific anti-HNE antibodies and auricle involvement, that help distinguish this condition from autoimmune vasculitis. Regardless, no optimal treatment has been described, steroids have been used preventing progressive damage but complete withdrawal is indispensable.