A young cocaine + male with HCV was admitted with an apparent cutaneous vasculitis and acute renal failure. Suspicion was high for cryoglobulinemia, but the cryocrit was normal. Skin biopsy was performed, showing a leukocytoclastic vasculitis, with positive stains for myeloperoxidase.
After further questioning and review of the recent literature (NEJM article) a diagnosis of levamisole-induced vasculitis and acute renal failure was diagnosed. Levamisole is a toxic veterinary compound used to cut cocaine, and is being seen with increasing frequency across the country. You can also click on the link to a recent network news media article: http://abcnews.go.com/Health/Wellness/flesh-eating-cocaine-laced-veterinary-drug-levamisole/story?id=13902353