Levamisole-Induced Cutaneous Vasculitis/Vasculopathy: A Concise Review

ABSTRACT: Levamisole-induced cutaneous vasculitis represents a distinctive form of drug-induced vasculopathy that has emerged as a significant clinical challenge, particularly since the widespread use of levamisole as a cocaine adulterant. This review provides a concise overview of this entity, with a specific focus on its epidemiology, pathophysiology, clinical presentation, histopathological features, immunological profile, and therapeutic management. Key clinical features include stellate or retiform purpura with a predilection for the ears and extremities, characteristic serological findings with mixed antineutrophil cytoplasmic antibody positivity, and distinctive histopathological patterns showing both leukocytoclastic vasculitis and thrombotic vasculopathy. Recognition of this entity is essential for accurate diagnosis and appropriate management, as its treatment differs substantially from that of primary antineutrophil cytoplasmic antibody-associated vasculitides. This review synthesizes current evidence to provide clinicians and pathologists with a practical overview of this increasingly recognized condition.