Cocaine contaminant Levamisole-induced polyangiitis and necrosis of the nasal cavity – a Scottish case series

Background: Common cocaine cutting agent Levamisole is known to cause agranulocytosis. However, a lesser known public health issue is levamisole-induced granulomatosis with polyangiitis. This case series explores this link. Methods and Results: A three case-series report with findings confirmed through clinical history, examination, biopsy and urine toxicology screens. Conclusions: Our case-series highlights a possible link between levamisole and extensive necrosis of the nasal cavity; caused by polyangiitis with granuloma formation and secondary vasculitis. A high degree of suspicion is needed if young patients present with ANCA positive vasculitis, or in patients with cocaine use, if there is a disproportionate destruction of tissuesparticularly the lateral wall of the nose. If diagnosed and treated early, this can be lifesaving.