Levamisole toxicity

Today's amuse-bouche was a case of a levamisole-related cutaneous vasculitis syndrome. A few quick points: 

• Recent trend in cocaine being adulterated by levamisole, 
• An anti-helminth agent in the 1960s first identified as a cocaine adulterant in the USA in 2003 
•  Now found in majority of cocaine seized at US borders, common in Canada also
• Proposed that levamisole potentiates the psychotropic effects of cocaine, and that producers intentionally add it during the cocaine manufacturing process 
• Associated with a cutaneous vasculitic syndrome 
• Purpuric lesions and/or cutaneous necrosis 
• Involves the ears in ~50% of reported cases 
• Lab associations: neutropenia + pANCA and + cANCA

More in a case-series review here.