Extensive levamisole-induced vasculitis

Desvignes, C.; Becquart, C.; Launay, David; Terriou, Louis; Patenotre, P; Deheul, Sylvie; Peytavin, Gilles; Dupin, Nicolas; Delaporte, E.; Staumont‐Sallé, D.

doi:10.1111/ced.13085

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…Suspected substances were levamisole ( n = 10), methaqualone and several benzodiazepines, caffeine and acetaminophen ( n = 1), 5F-MDMB- PINACA ( n = 7) and phenethylamine ( n = 1), asbestos ( n = 1) [ 33 , 42 , 44 , 45 , 46 , 47 , 52 , 53 , 54 , 55 , 56 ]. Considering all of the reported cases, levamisole was the most prevalent adulterating agent in street cocaine ( n = 17 cases) [ 33 , 42 , 44 , 45 , 46 , 47 , 54 , 57 , 58 , 59 , 60 , 61 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Trana

Berardinelli

Montanari

et al. 2022

IJMS

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Adulteration is a well-known practice of drug manufacturers at different stages of drug production. The intentional addition of active ingredients to adulterate the primary drug may enhance or mask pharmacological effects or may produce more potent drugs to increase the number of available doses and the dealer’s profit. Adulterants found in different drugs change over time in response to different factors. A systematic literature search in PubMed and Scopus databases and official international organizations’ websites according to PRISMA guidelines was performed. A total of 724 studies were initially screened, with 145 articles from PubMed and 462 from Scopus excluded according to the criteria described in the method section. The remaining 117 records were further assessed for eligibility to exclude articles without sufficient data. Finally, 79 studies were classified as “non-biological” (n = 35) or “biological” (n = 35 case reports; n = 9 case series) according to the samples investigated. Although the seized samples analyses revealed the presence of well-established adulterants such as levamisole for cocaine or paracetamol/acetaminophen for heroin, the reported data disclosed new adulteration practices, such as the use of NPS as cutting agents for classic drugs of abuse and other NPS. For example, heroin adulterated with synthetic cannabinoids or cocaine adulterated with fentanyl/fentalogues raised particular concern. Notably, adulterants play a role in some adverse effects commonly associated with the primary drug, such as levamisole-adulterated cocaine that may induce vasculitis via an autoimmune process. It is essential to constantly monitor adulterants due to their changing availability that may threaten drug consumers’ health.

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Section: Resultsmentioning

confidence: 99%

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Trana

Berardinelli

Montanari

et al. 2022

IJMS

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“…There are reports of agranulocytosis, multifocal leukoencephalopathy, ataxia, psychosis, fixed drug eruptions, necrotizing vasculitis and retiform purpura with levamisole. 2,3,4 Agranulocytosis (less than 20% neutrophils) due to levamisole occurs most frequently in patients with rheumatic diseases, in women, and in HLA B27 genotypes. 3 The pathogenesis behind neutropenia caused by levamisole is not fully understood.…”

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Levamisole Induced Agranulocytosis

Marimuthu¹,

Sp²,

Palaniappan³

2022

Pediatric Oncall

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“…Biological investigation revealed elevated C-reactive protein (60 mg/L, normal range 0-5 mg/ L) normocytic anaemia (haemoglobin 9.5 g/dL; normal range 13.0-18.0 g/dL) and hepatic cytolysis (transaminases and alkaline phosphatase three times the normal value, and gamma-glutamyltransferase 2fold above the normal value). [3][4][5] Leucocytoclastic vasculitis was associated with necrosis of the blood vessel walls and extravasation of erythrocytes (Fig.…”

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confidence: 99%

“…The pathogenesis of FUMHD is unclear. [3][4][5] There are no cases of drug-induced FUMHD in the literature. 1 The infiltration of CD8 lymphocytes around the epidermis and dermis, suggesting a cytotoxic attack of lymphocytes to altered epidermal antigens, could be an argument in favour of an immunological process.…”

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confidence: 99%

Febrile ulceronecrotic Mucha-Habermann disease after levamisole-adulterated cocaine use: an unusual case

et al. 2018

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A 47-year-old man presented with a febrile ulceronecrotic dermatosis. He reported intense use of levamisole-contaminated cocaine during the previous weeks.Physical examination revealed a high fever (40°C) combined with diffuse necrotic papulopustules involving 90% of the body surface ( Fig. 1a,b). The patient's condition rapidly worsened with severe respiratory distress. Biological investigation revealed elevated C-reactive protein (60 mg/L, normal range 0-5 mg/ L) normocytic anaemia (haemoglobin 9.5 g/dL; normal range 13.0-18.0 g/dL) and hepatic cytolysis (transaminases and alkaline phosphatase three times the normal value, and gamma-glutamyltransferase 2fold above the normal value). Tests for infectious disease (blood tests for varicella zoster virus, herpes simplex virus, human immunodeficiency virus, hepatitis B and C viruses, human herpes virus(HHV)-6 and HHV-8, syphilis, Epstein-Barr virus, cytomegalovirus, Pneumococcus, Mycoplasma pneumoniae, bacterial and mycological cutaneous samples and blood cultures) were negative, as were screening tests for autoimmunity.Thoracic computed tomography scan showed ground-glass opacities in the upper lobes combined with perihilar cylindrical bronchodilation.Histopathology of a skin biopsy revealed a diffuse dermoepidermal lymphocyte and neutrophil infiltrate. Leucocytoclastic vasculitis was associated with necrosis of the blood vessel walls and extravasation of erythrocytes (Fig. 2).Based on the clinicopathological findings, febrile ulceronecrotic Mucha-Habermann disease (FUMHD) was suggested.Systemic steroids 1 mg/kg/day were promptly administered, but the patient's condition deteriorated with severe dyspnoea and extension of the cutaneous lesions. Chest radiography confirmed a worsened interstitial pneumonia, leading to an emergency orotracheal intubation. Intravenous immunoglobulin (IVIG) 2 g/kg (IVIG) resulted in a favourable respiratory and cutaneous response in a few days. IVIG was continued twice a month for a year, producing improvement in skin lesions (Fig. 1c) and liver function tests. After 22 months of follow-up, only hyperpigmented scars (Fig. 1d) were noted. Since then, the patient has completely stopped his cocaine use.FUMHD is considered as a rare and severe variant of pytiriasis lichenoid and varioliformis acuta (PLEVA), with a potentially life-threatening prognosis due to severe systemic visceral involvement. The pathogenesis of FUMHD is unclear. A complex immune vasculitis related to a hypersensitivity reaction towards an infectious antigen has been suspected. 1 The infiltration of CD8 lymphocytes around the epidermis and dermis, suggesting a cytotoxic attack of lymphocytes to altered epidermal antigens, could be an argument in favour of an immunological process. 2 Levamisole is an imidazothiazole drug often used as an adulterant in drugs to produce a better stimulant effect and to increase the drug weight. It has immunostimulant properties, which may result in a leucocytoclastic vasculitis. Levamisole has been reported to cause severe cutaneous vascul...

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Extensive levamisole-induced vasculitis

Cited by 10 publications

References 7 publications

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances

Levamisole Induced Agranulocytosis

Febrile ulceronecrotic Mucha-Habermann disease after levamisole-adulterated cocaine use: an unusual case

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