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1-4 Levamisole was banned in 2000 after reports of associated agranulocytosis and a characteristic painful purpuric vasculitis. Levamisole is a veterinary anthelmintic drug with immunomodulating properties that was once approved by the US Food and Drug Administration for the treatment of various conditions, including autoimmune diseases, cancer, pediatric kidney disease, and chronic infections. ANCA-positive necrotizing vasculitis and thrombotic vasculopathy induced by levamisole-adulterated cocaine: a distinctive clinicopathologic presentation. Characteristic purpura of the ears, vasculitis, and neutropenia-a potential public health epidemic associated with levamisole-adulterated cocaine. The hairy-print for levamisole-induced vasculitis. Lazareth H, Peytavin G, Polivka L, et al.Levamisole exposure and hematologic indices in cocaine users. Cutaneous vasculopathy and neutropenia associated with levamisole-adulterated cocaine. Vasculopathy related to cocaine adulterated with levamisole: a review of the literature. Cocaine-associated retiform purpura and neutropenia: is levamisole the culprit? J Am Acad Dermatol. Waller JM, Feramisco JD, Alberta-Wszolek L, et al.Determination of levamisole in urine by gas chromatography-mass spectrometry. Trehy ML, Brown DJ, Woodruff JT, et al.A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Gross RL, Brucker J, Bahce-Altuntas A, et al.Agranulocytosis after consumption of cocaine adulterated with levamisole. Agranulocytosis associated with cocaine use-four states, March 2008–November 2009. Centers for Disease Control and Prevention (CDC).Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children.
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Rongioletti F, Ghio L, Ginevri F, et al.Mechanism of levamisole-induced granulocytopenia in breast cancer patients. Vogel CL, Silverman MA, Mansell PW, et al.Ear lobe necrosis by levamisole-induced occlusive vasculitis in a pediatric patient.
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