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  • Title: Necrosis of ears after use of cocaine probably adulterated with levamisole.
    Author: de la Hera I, Sanz V, Cullen D, Chico R, Petiti G, Villar M, Burgués M, Sanz J, Castellanos M, Zarco O, Ortiz PL, Rodríguez-Peralto JL, Vanaclocha F.
    Journal: Dermatology; 2011; 223(1):25-8. PubMed ID: 21846960.
    Abstract:
    BACKGROUND/AIMS: Levamisole is an anthelminthic drug with immunomodulatory properties that has been found to be an adulterant of cocaine in the last 2 years. It was present at least in 70% of tainted cocaine in the U.S.A. in 2009. METHODS: We present the case of a 40-year-old patient with a history of weekend cocaine use who consulted for bilateral necrotic lesions in the ears that had appeared 3 days after the last use. RESULTS: Levamisole causes a typical clinical picture characterized by bilateral necrosis of the ears, positive perinuclear antineutrophil cytoplasmic antibodies and laboratory findings of antiphospholipid syndrome, such as anticardiolipin antibodies and/or lupus anticoagulant. CONCLUSION: Dermatologists should be aware of this new entity, which is likely to be more and more frequent due to the increasing use of cocaine. Here we describe a clinical case that is likely to be secondary to levamisole-tainted cocaine and review the literature.
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