Levamisole-induced and COVID-19-induced retiform purpura: two overlapping, emerging clinical syndromes

Catherine K. Keim, Robert A. Schwartz, Rajendra Kapila

Research output: Contribution to journalArticlepeer-review


Levamisole exposure in cocaine users is a well-recognized cause of retiform purpura, a distinctive net-like maculopapular patch. Prolonged exposure to levamisole can lead to a serious systemic syndrome known as levamisole-induced vasculitis, most commonly involving the kidneys and lungs. More recently, retiform purpura has been observed in patients with the novel coronavirus disease of 2019 (COVID-19). Due to their overlapping dermatologic and systemic manifestations, levamisole-induced and COVID-19-induced retiform purpura may mimic one another in clinical presentation. The possibility that patients may present with one or both syndromes creates a diagnostic challenge. This review of levamisole-induced and COVID-19-induced retiform purpura highlights their corresponding and distinctive features. Additionally, we propose a unique staging system for levamisole-induced retiform purpura that may be valid for future classification of COVID-19-induced retiform purpura.

Original languageAmerican English
Pages (from-to)265-273
Number of pages9
JournalArchives of Dermatological Research
Issue number2
StatePublished - Mar 2023

ASJC Scopus subject areas

  • Dermatology


  • COVID-19
  • Cocaine
  • Drug abuse
  • Levamisole
  • Neutrophils
  • Retiform purpura
  • Vasculitis


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