Ahmad M A Al-Khashman

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• Dherange, P. A., Al-khashman, A., Dherange, P. A., Beatty, N., & Al-khashman, A. (2015). Levamisole-adulterated cocaine: a case of retiform purpura, cutaneous necrosis and neutropenia.. BMJ case reports, 2015, bcr2015211768. doi:10.1136/bcr-2015-211768
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  A 53-year-old man presented to the emergency department with symptoms of bilateral ear pain that developed over the past 8 h. The patient was a chronic cocaine user for the past 35 years and had last inhaled ‘crack cocaine’ on the day of presentation. On examination, both auricles were erythematous and painful to the touch (figure 1). Palpable, non-blanching retiform purpura were evident with a similar non-blanching erythematous patch on both cheeks (figure 2). The anterior portions of both lower extremities had developing purpura (figure 3). Skin necrosis was also found on the right hand (figure 4). Figure 1 Right auricle with haemorrhagic and necrotic lesions in levamisole-associated vasculitis. Figure 2 Characteristic retiform purpura noted on right cheek. Figure 3 Small purpuric …