Emerg Med J doi:10.1136/emermed-2012-202203
  • Images in emergency medicine

Pain in the pinnae: a sign of levamisole vasculopathy

  1. Kachiu C Lee2
  1. 1Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Department of Dermatology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Barry Ladizinski, Department of Dermatology, Duke University Medical Center, Box 2822, Durham, NC 27710, USA; barryladizinski{at}
  • Received 26 November 2012
  • Revised 26 November 2012
  • Accepted 28 November 2012
  • Published Online First 12 January 2013

A 61-year-old man presented with fatigue, arthralgias and a tender rash on his ears in the setting of recent cocaine use. Physical examination revealed purpuric dark purple patches with haemorrhagic bullae on the bilateral helical rims (figures 1 and 2). Laboratory investigation was significant for a serum sodium of 130 mmol/l (normal range, 135–145) and positive perinuclear antineutrophil cytoplasmic …

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