Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children

The cutaneous side-effects of levamisole include non-specific and lichenoid eruptions, fixed drug eruption and, very rarely, cutaneous vasculitis, We describe a distinctive clinical and histological vasculopathy with immunolo gical abnormalities in children with paediatric nephrotic syndrome receivin g long-term levamisole treatment, Four boys and one girl were identified, T heir average age was 10 years. Levamisole had been used for an average of 2 4 months. Purpura of the ears was the most common finding corresponding his tologically to a vasculopathic reaction pattern ranging from a leucocytocla stic and thrombotic vasculitis to a vascular occlusive disease without true vasculitis but with associated antinuclear, antiphospholipid and anticytop lasmic antibodies, The eruption resolved in all patients 2-3 weeks after th e discontinuation of levamisole, but serum autoantibodies persisted for 2-1 4 months.