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The manifestations of habitual cocaine use can mimic tumors, infections, and immunologic diseases and can affect multiple organs, causing nasal septal perforation, cutaneous vasculitis, vasculopathic skin necrosis, pyoderma gangrenosum (PG),1 and lung disease.2 Levamisole is a veterinary antiparasitic drug often added to cocaine in the United States to cheaply enhance or extend cocaine's euphoric effects. It is present in about 70% of seized cocaine in the United States, and it is believed to play a direct role in induction of vasculopathy, vasculitis, and PG.1 Early distinction of these disorders can be challenging. Here we present a case of cocaine abuse disorder manifesting as cutaneous and nasal mucosal PG, perforated nasal septum, and pneumonitis.

Nasal septal and mucosal disease associated with pyoderma gangrenosum in a cocaine user