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Levamisole induced skin vasculitis/vasculopathy is a relatively new diagnosis with limited knowledge about the underlying mechanism of above manifestation. The most commonly reported cause is the generation of autoantibodies against myleoperoxidase and other neutrophilic enzymes hence commonly mimicking ANCA associated vasculitis. We present a case report of 52 years old female with history of levamisole induced vasculitis in past and presented with >40% body surface area involvement after being re-exposed to levamisole tainted cocaine. Though recurrence of lesions has been documented on re-exposure to levamisole laced cocaine but extensive skin necrosis has not been documented in the literature.
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