Fulminant toxic vasculitis caused by cocaine/tusi-levamisole: a challenge in intensive care. A case report
Fernando Victor Manuel Santacruz-Castiblanco, Álvaro Francisco Rosas-Insuasty, Juan Santiago Serna Trejos, P. López Garzon, Carolina Reyes-Vente, María del Rosario Rojas-Becerra, Kelly Gómez Galeano
LAJEC - Latin American Journal of Emergency Care July 22, 2026 DOI: 10.54143/lajec.v6i1.325 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 31-year-old woman with a history of remote ischemic stroke |
| Interventions | Multimodal analgesia anticoagulation methylprednisolone pulses benzodiazepines nitroglycerin dialysis |
| Key findings | The authors describe a young woman who developed severe limb ischemia and rhabdomyolysis (CPK above 20,000 U/mL) after using cocaine and 2C-B, leading to bilateral transtibial amputation at 96 hours. They argue that psychoactive substances such as tusi, a mixture that may contain contaminants like levamisole, can cause vasculitis and that targeted history taking and multidisciplinary coordination are needed for timely decisions. |
Abstract
We describe the case of a 31-year-old woman with a history of remote ischemic stroke who presented with 24 hours of severe lower extremity pain that rapidly progressed to distal cyanosis, coldness, and absent distal pulses. Computed tomography angiography showed diffuse narrowing of the arteries and thready contrast passage in the bilateral iliac, femoral, popliteal, and tibial arteries, without arterial thrombosis. Partial thrombosis of an intrahepatic branch of the portal vein with areas of hepatic ischemia was also documented. She was admitted to the ICU for multimodal analgesia, anticoagulation, and methylprednisolone pulses due to initial suspicion of vasculitis, with close monitoring of distal perfusion. After admitting to cocaine, 2C-B, and 2C-B use, toxicology recommended treatment of vasospasm with benzodiazepines and nitroglycerin, and ketamine was discontinued. Progressive hypoperfusion and marked rhabdomyolysis (CPK >20,000 U/mL) persisted, with preserved renal function; dialysis therapy was initiated as support. At 96 hours, the injury was considered irreversible, and bilateral transtibial amputation was performed. This case discusses the diagnostic and therapeutic challenge of vasculitis caused by psychoactive substances such as tusi, which is composed of a mixture of several psychoactive substances and may contain contaminants such as levamisole, highlighting the need for targeted history taking, multidisciplinary coordination, and timely decisions in previously healthy young patients. Keywords: “Tusi"; "Cocaine"; “Psychoactive substances”; "Levamisole"; "Vasculitis"; "Rhabdomyolysis"; "Intensive Care Units" (MeSH/DeCS)