Levamisole-induced vasculitis with ecchymosis and necrosis syndrome from contaminated cocaine

A 43-year-old-man presented with 1-month history of progressive erythematous painful lesions over multiple sites involving bilateral lower extremities, trunk and pinnae. He was a chronic cocaine user; last use was 3 days prior to presentation. On examination he had bilateral large retiform, geometric, dusky, erythematous, tender plaques with central necrosis and ecchymosis over aforementioned areas …