TY - CHAP M1 - Book, Section TI - Levamisole-Associated Purpura A1 - Yazdany, Jinoos A1 - Manno, Rebecca A1 - Hellmann, David B. A1 - Imboden Jr., John B. A2 - Papadakis, Maxine A. A2 - McPhee, Stephen J. A2 - Rabow, Michael W. PY - 2021 T2 - Current Medical Diagnosis & Treatment 2021 AB - Exposure to levamisole, a prevalent adulterant of illicit cocaine in North America, can induce a distinctive clinical syndrome of retiform purpura and cutaneous necrosis affecting the extremities, ears, and skin overlying the zygomatic arch. Biopsies reveal widespread thrombosis of small cutaneous vessels with varying degrees of vasculitis. The syndrome is associated with the lupus anticoagulant, IgM antibodies to cardiolipin, and very high titers of p-ANCAs (due to autoantibodies to elastase, lactoferrin, cathepsin-G, and other neutrophil components rather than to myeloperoxidase alone). There is no consensus on treatment of levamisole-induced purpura, but early lesions can resolve with abstinence. Use of levamisole-adulterated cocaine also has been linked to neutropenia, agranulocytosis, and pauci-immune glomerulonephritis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2022/08/19 UR - accessmedicine.mhmedical.com/content.aspx?aid=1175803591 ER -