Case Number : CT0070 Adam_Bates

I think this might be vasculitis induced by levamisole used as a cutting agent in cocaine. The ears are a characteristic location.
 

Wegener's granulomatosis
 

Drug induced leucocytoclastic vasculitis.
 

Dr. Saleem is probably correct. Two more considerations: tha age of the patient is consistent with cocaine abuse and the bilateral involvement of the ears are common is thie entity.
I read previously that this was a true vasculitis, but others authors tell that this is a vasculopathic process, with no true vasculitis. Would like to know the opinion of the colleagues.

Fully agree with Saleem. Sparse neutrophils and rare red cells in vessel walls, and marked endothelial cell reactive ballooning, but no significant dermal hemorrhage, fibrin thrombi, or fibrinoid vessel wall changes.

The clinical history makes the diagnosis--sometimes without any help from us--as classic vasculitis findings can be subtle (as seen here) or occasionally absent. I wonder if the vasoconstrictive effects of cocaine are synergistic with the effects of levamisole-induced vasculitis, in precipitating an acute ischemia and subsequent necrosis.