Levamisole-induced vasculopathy: A report of 2 cases and a novel histopathologic finding

Reza S. Jacob, Claudine Yap Silva, Jennifer G. Powers, Stefan M. Schieke, Gary Mendese, Rufus W. Burlingame, Daniel D. Miller, Deon Wolpowitz, Emmy Graber, Meera Mahalingam

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Although 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.

Original languageEnglish (US)
Pages (from-to)208-213
Number of pages6
JournalAmerican Journal of Dermatopathology
Issue number2
StatePublished - Apr 1 2012


  • levamisole-induced vasculopathy
  • neovascularization


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