{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T21:00:17Z","timestamp":1770152417048,"version":"3.49.0"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,8,7]]},"abstract":"<jats:p>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\u2013levamisole-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.<\/jats:p>","DOI":"10.1136\/bcr-2015-210970","type":"journal-article","created":{"date-parts":[[2015,8,26]],"date-time":"2015-08-26T09:57:38Z","timestamp":1440583058000},"page":"bcr2015210970","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Levamisole-contaminated cocaine: a hairy affair"],"prefix":"10.1136","volume":"2015","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3085-603X","authenticated-orcid":false,"given":"Tjeerd","family":"van der Veer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ed","family":"Pennings","sequence":"additional","affiliation":[{"name":"Department of Toxicology, Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J W Cohen","family":"Tervaert","sequence":"additional","affiliation":[{"name":"SFVG Academy, Sint Franciscus Vlietland Groep, Rotterdam, the Netherlands"},{"name":"Clinical and Experimental Immunology, Maastricht University, Maastricht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindy-Anne","family":"Korswagen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,8,26]]},"reference":[{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.1","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/S0140-6736(04)17183-3","article-title":"A difficult diagnosis","volume":"364","author":"Cohen Tervaert","year":"2004","journal-title":"Lancet"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-011-1805-3"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.3","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2010.156"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.ftd.0000211811.27558.b5"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.5","doi-asserted-by":"crossref","first-page":"pii: bcr2012006602","DOI":"10.1136\/bcr-2012-006602","article-title":"The hairy-print for levamisole-induced vasculitis","volume":"2012","author":"Lazareth","year":"2012","journal-title":"BMJ Case Rep"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.6","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-012-8320-4"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.burns.2014.10.032"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5070\/D36G18R9CV","article-title":"Vasculopathy related to cocaine adulterated with levamisole: a review of the literature","volume":"18","author":"Pearson","year":"2012","journal-title":"Dermatol Online J"},{"key":"2025082801345737000_2015.aug26_1.bcr2015210970.9","doi-asserted-by":"crossref","unstructured":"Hilhorst M , van Paassen P , Tervaert JWC , Registry for the LR. 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