A retrospective review of four patients with severe nasal destruction secondary to cocaine adulterated with levamisole.

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Cocaine is increasingly found to be adulterated with levamisole Cocaine can cause cocaine induced midline destructive lesions, severe destruction limited to the nasal region Levamisole adulterated cocaine may cause levamisole induced vasculitis, a systemic vasculitis which features midline destruction There is overlap between these two conditions and patients may present with features of both; however, there are no clear diagnostic or treatment criteria A high index of suspicion must be maintained in order to diagnose these conditions and potentially avoid immunosuppression; debridement of nasal lesions provides good symptomatic relief, but abstinence should be proven prior to reconstruction.

View the full article @ Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
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