• Reza S Jacob, Claudine Yap Silva, Jennifer G Powers, Stefan M Schieke, Gary Mendese, Rufus W Burlingame, Daniel D Miller, Deon Wolpowitz, Emmy Graber, and Meera Mahalingam.
• Department of Dermatology, Boston University School of Medicine,609 Albany Street, Boston, MA 02118, USA.
• Am J Dermatopathol. 2012 Apr 1;34(2):208-13.

AbstractAlthough 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.

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