Adulterated cocaine with levamisole can cause a multitude of pathological and skin findings.

What is it about?

Cocaine is now known to be adulterated with levamisole to add volume to the drug and to potentiate psychotropic properties of it. People who use adulterated cocaine with levamisole can present with a syndrome with interesting and very pathognomic skin findings. We should familiarize ourselves with the multitude of pathological and skin findings that adulterated cocaine can cause and make ourselves aware that the classical pathological finding of vasculitis in such cases is not always seen.

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Why is it important?

Cocaine is one of the most trafficked illicit drug in the world and in the United States, remains to be the most often reported illegal drug in the emergency departments. Therefore, the clinical manifestations and recognition of clinical findings in someone suspected of adulterated cocaine exposure are essential to avoid delay in diagnosis and appropriate management.