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Review
. 2011;223(1):25-8.
doi: 10.1159/000329436. Epub 2011 Aug 16.

Necrosis of ears after use of cocaine probably adulterated with levamisole

I de la Hera  1 , V Sanz, D Cullen, R Chico, G Petiti, M Villar, M Burgués, J Sanz, M Castellanos, O Zarco, P L Ortiz, J L Rodríguez-Peralto, F Vanaclocha
Affiliations
Review

Necrosis of ears after use of cocaine probably adulterated with levamisole

I de la Hera et al. Dermatology. 2011.

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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