Pathology: levamisole vasculitis

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

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