Levamisole vasculopathy
QUESTION 21
A 37-year-old woman is evaluated by the dermatology consult service in the emergency department, where she presented with a new painful rash on the legs. She reports that the rash began on her legs but quickly spread to her trunk, arms and ears over the past 48 hours. The lesions were initially non-tender but have become intensely tender to palpation. Her past medical history is notable for polysubstance abuse and infective endocarditis. On examination, there are numerous purpuric plaques with irregular, stellate borders. Some of the larger lesions have hemorrhagic bullae in the centre with evidence of necrosis (21).
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