Cocaine-induced leukoencephalopathy is a rare neurological condition usually associated with substances used to adulterate cocaine. A common adulterant of cocaine includes levamisole, an anti-helminthic agent, causing pathologies including vasculitis, agranulocytosis, and, in rare cases, leukoencephalopathy when ingested. Here, the authors present a comprehensive analysis of a cocaine-induced leukoencephalopathy case with the likely presence of levamisole. The patient, a 31-year-old male with an unknown past medical history, presented to the emergency department with seizure-like activity, stiffness, and posturing. Signal abnormalities found in imaging can be seen in the setting of acute cocaine-induced leukoencephalopathy and other metabolic etiologies. The patient was admitted to the neurocritical care unit for management of toxic leukoencephalopathy, acute respiratory failure with hypoxia, non-traumatic rhabdomyolysis, aspiration pneumonia, acute renal failure, and hypertensive emergency. After a 12-day hospitalization, the patient improved towards baseline and continued follow-up for further management. The case study exhibits the importance of early recognition and treatment o
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