Fellow’s Forum Case Report: True Vasculitis or Vasculitis Mimic?

There are no set recommendations for the treatment of levamisole-associated vasculopathy. In many reported cases, the skin disease was self-limited and resolved upon cessation of cocaine use.² Several of our patients received pulses or short courses of oral prednisone. Although the skin lesions are thrombotic and not inflammatory, we found that our patients responded rapidly to steroid treatment. However, there appears to be no role for chronic immunosuppressive therapy.

We suspect the frequency of levamisole-induced vasculopathy will continue to increase as clinicians become aware of the clinical presentation. The differential diagnosis of levamisole-induced vasculopathy should be entertained when faced with necrotic lesions suggestive of vasculitis. A careful history, urine drug screening, and serological testing should point one toward the correct diagnosis. The importance of recognizing levamisole-induced vasculopathy lies in the fact that cessation of use of the levamisole-contaminated drug is the key treatment, rather than immunosuppression and/or anticoagulation therapy.

At the time of writing this article, Drs. Joshi, Gupta, and Park were fellows in the division of rheumatology at Washington University/Barnes-Jewish Hospital in St. Louis. Dr. Joshi is now in clinical practice in Beaumont, Texas. Dr. Gupta is in practice in Gulfport, Miss. Dr. Pham is an associate professor at Washington University/Barnes-Jewish Hospital. Dr. Kahl is professor in the division of rheumatology at Oregon Health Science Center in Portland. Dr. Park is pursuing a third year fellowship.

References

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