Levamisole-induced vasculopathy: a report of 2 cases and a novel histopathologic finding.

Journal Article (Journal Article)

Although cocaine-induced pseudovasculitis and urticarial vasculitis have been reported in the past, levamisole-induced vasculopathy with ecchymosis and necrosis, termed here LIVEN, has only recently been described in association with cocaine use. Levamisole, a veterinary antihelminthic agent used previously as an immunomodulating agent, is present as a "cutting agent" in approximately two-thirds of the cocaine currently entering the United States. Levamisole is believed to potentiate the effects of cocaine and may also be used as a "signature" for tracing its market distribution. Herein, we report 2 cases of LIVEN in patients with histories of chronic cocaine use. In both the cases, a temporal association with neutropenia preceding the eruption was noted. A novel histopathologic finding present only in the second case was the presence of extensive interstitial and perivascular neovascularization. Our 2 cases reaffirm that neutropenia may precede the cutaneous eruption of LIVEN. Case 2 extends the spectrum of histopathologic findings to include the novel phenomenon of neovascularization-hitherto unreported in this entity.

Full Text

Duke Authors

Cited Authors

  • Jacob, RS; Silva, CY; Powers, JG; Schieke, SM; Mendese, G; Burlingame, RW; Miller, DD; Wolpowitz, D; Graber, E; Mahalingam, M

Published Date

  • April 2012

Published In

Volume / Issue

  • 34 / 2

Start / End Page

  • 208 - 213

PubMed ID

  • 22094232

Electronic International Standard Serial Number (EISSN)

  • 1533-0311

Digital Object Identifier (DOI)

  • 10.1097/DAD.0b013e31821cc0bf


  • eng

Conference Location

  • United States