Disease summary is provided courtesy of VisualDx, the visual diagnostic decision support system for health care professionals. To view more images of Cocaine Levamisole Toxicity and other visually presenting diseases and adverse drug reactions, log in to VisualDx or try it now. Diagnosis Synopsis Cocaine Levamisole Toxicity : Cocaine contaminated with levamisole has been detected in the United States since 2003, and the incidence of toxicity caused by this contamination has been increasing rapidly since 2008. Use of cocaine that has been adulterated with levamisole can lead to a constellation of symptoms including agranulocytosis, neutropenia, and a vasculitis-like purpuric tender skin eruption. The most common sites of purpura are the external ears and cheeks. The purpura is generally followed by skin necrosis, but resolves several weeks after cessation of cocaine use. Recurrent use of contaminated cocaine generally results in recurrent skin eruptions.