Unusual Case of Pyoderma Gangrenosum and Bilateral Ear Changes Secondary to the Use of Cocaine with Levamisole in a Patient with Systemic Lupus Erythematosus

The knowledge of skin as well as ear complications caused by cocaine with levamisole is evolving. We described a patient with primary autoimmune rheumatological disorderSystemic Lupus Erythematosus (SLE) as well as Chronic Hepatitis C and Pyoderma Gangrenosum (PG) as well as ear changes which might be in differential diagnosis of Relapsing Polychondritis (RP). Also the patient had positive PANCA and CANCA antibodies as well as elevated titers of ANA and decreased complement levels of C3, C4, CH50. Although pyoderma gangrenosusm is described in patients with SLE, hepatitis C etc. the time course of consumption of cocaine with levamisole as well antibody changes described were typical for drug induced ear changes and pyoderma gangrenosum. We think clinicians should always include the urine/ blood drug test when dealing with those disorders to exclude drug induced pyoderma gangrenosusum and ear changes, before attributing those changes to primary rheumatological or infectious disorder.