TY - JOUR T1 - Levamisole-contaminated cocaine: a hairy affair JF - BMJ Case Reports DO - 10.1136/bcr-2015-210970 VL - 2015 SP - bcr2015210970 AU - Tjeerd van der Veer AU - Ed Pennings AU - J W Cohen Tervaert AU - Lindy-Anne Korswagen Y1 - 2015/08/26 UR - http://casereports.bmj.com/content/2015/bcr-2015-210970.abstract N2 - Levamisole-contaminated cocaine can induce severe systemic vasculitis. The diagnosis can be challenging, especially when substance abuse is uncertain. We present the case of a 42-year-old woman suffering from vasculitis due to levamisole-contaminated cocaine, who persistently denied substance abuse. Symptoms included ulcerating skin lesions, arthralgia and myalgia, and the occurrence of an ileal intussusception. The definitive diagnosis was made using hair testing for toxins. She recovered through cocaine abstinence, but re-exposure resulted in a severe relapse with glomerulonephritis. Importantly, at time of the relapse, the patient became positive for both myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA. Cocaine–levamisole-induced vasculitis poses a great clinical challenge. The proper diagnostic strategy and therapy is still controversial. We highlight our diagnostic and therapeutic considerations, including hair testing for definitive proof of exposure. ER -