ANCA-Associated Intrahepatic Duct Injury Associated with Levamisole-Adulterated Cocaine

Salabei, Joshua K.; Khan, Sara; Khan, Afzal; Asnake, Zekarias T.; Fishman, Troy J.; Stromas, Jonathan D.; Ismail, Zeeshan; Leibach, John R.

doi:10.1155/2020/8867183

Cited by 4 publications

(5 citation statements)

References 10 publications

(2 reference statements)

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“…However, the biochemical changes seen with each drug treatment do not indicate liver damage. These results differ from a recent report of a levamisole‐adulterated cocaine user that presented hepatic damage 47 . Also, an analysis in lambs reported that a levamisole dose (20 mg/kg) similar to the one used in this study (17.7 mg/kg, i.p.)…”

Section: Discussioncontrasting

confidence: 99%

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Co‐administration of morphine and levamisole increases death risk, produces neutropenia and modifies antinociception in mice

et al. 2022

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Levamisole is a veterinary anthelmintic drug and a common adulterant of misused drugs. This study analyses the lethal, antinociceptive and haematological effects produced by acute or repeated levamisole administration by itself or combined with morphine. Independent groups of male Swiss Webster mice were i.p. injected with 100 mg/kg morphine, 31.6 mg/kg levamisole (lethal doses at 10%, LD 10 ) or the same

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Section: Discussioncontrasting

confidence: 99%

“…These results differ from a recent report of a levamisole-adulterated cocaine user that presented hepatic damage. 47 Also, an analysis in lambs reported that a levamisole dose (20 mg/kg) similar to the one used in this study (17.7 mg/kg, i.p.) increased liver enzymes.…”

Section: Discussionmentioning

confidence: 56%

Co‐administration of morphine and levamisole increases death risk, produces neutropenia and modifies antinociception in mice

et al. 2022

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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%

“…Generally, ANCA positivity is a marker of autoimmune pathologies including systemic autoimmune vasculitis, necrotising crescentic glomerulonephritis, inflammatory bowel disease and other autoimmune pathologies [ 63 ]. In levamisole-adulterated cocaine intoxications [ 33 , 44 , 45 , 46 , 47 , 54 , 57 , 58 , 59 , 60 , 61 , 62 ] the p- or c-ANCA positivity was associated with Cocaine Induced Midline Destructive Lesions (CIMDL) ( n = 5) [ 44 , 57 ], vasculitis ( n = 8) [ 33 , 47 , 58 , 59 , 60 , 61 ], membranous glomerulonephritis ( n = 4) [ 58 , 62 ], pyoderma gangrenosum ( n = 1) [ 54 ], neutropenia complicated with bowel necrosis ( n = 1) [ 46 ], and cerebral white matter dysfunction ( n = 1) [ 45 ]. These autoimmune pathologies were more frequent in women (100% ANCA positivity) than men (90% of ANCA positivity) [ 64 ].…”

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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“…Less is known about cocaine’s effects on venous endothelial cells, although other cases of cocaine-induced pulmonary embolism exist [ 6 , 7 ]. It has been found that adulterants like levami-sole, which is present in 69% of cocaine samples, are known to cause pulmonary damage, including pulmonary fibrosis [ 10 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

Episodic Cocaine Use as a Cause of Venous Thromboembolism and Acute Liver Injury

Patel,

Thomas,

Stacey

2023

Am J Case Rep

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Patient: Male, 34-year-old Final Diagnosis: Venous thromboembolism secondary to cocaine use Symptoms: Shortness of breath Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unknown etiology Background: Pulmonary embolism secondary to deep vein thrombosis (DVT) with cor pulmonale is commonly associated with risk factors including surgery, cancer, and prolonged immobility. Cocaine is known to cause vasoconstriction and has a prothrombotic effect. Prolonged and heavy use of cocaine can also cause inflammation and liver damage. However, data on its potential role in causing pulmonary embolism and direct hepatotoxicity in cases of episodic use are scarce. Case Report: A 34-year-old man with no significant medical history except for episodic cocaine use presented in respiratory distress. Workup revealed submassive pulmonary embolism with pulmonary infarctions complicated by pneumonia, hypoxemic respiratory failure, and anemia. He was treated with anticoagulation and intensive care. On day 5 of hospitalization, the patient had an acute hepatic injury. His alanine aminotransferase level peaked at over 2000 IU/L on day 7, until finally tapering. Liver failure was found to be secondary to cocaine use. Liver enzyme levels improved with supportive care. He was discharged with apixaban and continued liver enzyme monitoring. Conclusions: When investigating the cause of venous thromboembolism and transaminitis, evaluating cocaine use via patient history or laboratory analysis of cocaine and its metabolites should be considered. Cocaine is known to cause vasoconstriction and has a prothrombotic effect, although data on its potential role in causing pulmonary embolism and direct hepatotoxicity in cases of episodic use are scarce. Further investigation, such as cohort studies, could help strengthen our understanding of the relationship between cocaine use, acute hepatic injury, and pulmonary embolism.

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ANCA-Associated Intrahepatic Duct Injury Associated with Levamisole-Adulterated Cocaine

Cited by 4 publications

References 10 publications

Co‐administration of morphine and levamisole increases death risk, produces neutropenia and modifies antinociception in mice

Co‐administration of morphine and levamisole increases death risk, produces neutropenia and modifies antinociception in mice

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

Episodic Cocaine Use as a Cause of Venous Thromboembolism and Acute Liver Injury

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