LAUSR

ANA: anti-nuclear antibody BLE: bilateral lower extremities MPO: myeloperoxidase NPWT: negative-pressure wound therapy p-ANCA: perinuclear anti-neutrophil cytoplasmic antibodies PR3: proteinase 3 TBSA: total body surface area VAC: vacuum-assisted closure INTRODUCTION Levamisole is an anthelmintic drug initially used to treat parasitic worm infections in addition to various cancers and immunologic disease processes such as rheumatoid arthritis, lichen planus, and Crohn’s disease due to its immunomodulatory properties. However, levamisole was withdrawn from the market in 1999 because of reported side effects, including agranulocytosis and skin vasculitis. In the veterinary world, it continues to be used as a deworming medication. Studies have also suggested that levamisole may lead to central nervous system complications, such as leukoencephalopathy. As of 2019, approximately 80% of the cocaine consumed in the United States was contaminated with levamisole to potentiate the stimulatory effects of cocaine and increase its bulk. Levamisoleinduced vasculitis typically presents as a purpuric rash, which typically arises on the ears, cheeks, face, extremities, buttocks, and thighs. The rash may exhibit areas of necrosis and can progress to a fullthickness wound. Histology typically demonstrates thrombotic or leukocytoclastic vasculitis and sometimes vascular occlusion. Though the diagnosis is one of exclusion, the aforementioned cutaneous manifestations, a history of cocaine use, arthralgias, leukopenia, and positive anti-neutrophil cytoplasmic antibody (ANCA) titers should raise suspicion for levamisole-induced vasculitis. If levamisole-induced vasculitic wounds progress to full-thickness necrosis, surgical intervention may be required. To date, there is no widely-accepted