Levamisole-contaminated cocaine: a hairy affair

Tjeerd van der Veer, Ed Pennings, J W Cohen Tervaert, Lindy-Anne Korswagen

Research output: Contribution to journalArticleAcademicpeer-review


Levamisole-contaminated cocaine can induce severe systemic vasculitis. The diagnosis can be challenging, especially when substance abuse is uncertain. We present the case of a 42-year-old woman suffering from vasculitis due to levamisole-contaminated cocaine, who persistently denied substance abuse. Symptoms included ulcerating skin lesions, arthralgia and myalgia, and the occurrence of an ileal intussusception. The definitive diagnosis was made using hair testing for toxins. She recovered through cocaine abstinence, but re-exposure resulted in a severe relapse with glomerulonephritis. Importantly, at time of the relapse, the patient became positive for both myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA. Cocaine-levamisole-induced vasculitis poses a great clinical challenge. The proper diagnostic strategy and therapy is still controversial. We highlight our diagnostic and therapeutic considerations, including hair testing for definitive proof of exposure.

Original languageEnglish
JournalBMJ case Reports
Publication statusPublished - 26 Aug 2015


  • Adjuvants, Immunologic
  • Adult
  • Antibodies, Antineutrophil Cytoplasmic
  • Cocaine
  • Cocaine-Related Disorders
  • Drug Contamination
  • Female
  • Glomerulonephritis
  • Hair
  • Humans
  • Levamisole
  • Peroxidase
  • Recurrence
  • Vasculitis

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