Levamisole‐induced occlusive necrotising vasculitis in cocaine abusers: an unusual cause of skin necrosis and neutropenia

Belfonte, Cassius; Shanmugam, Victoria K.; Kieffer, Nicole; Boucree, Suelyn; Kerr, Gail S.

doi:10.1111/j.1742-481x.2012.01027.x

Cited by 19 publications

(9 citation statements)

References 44 publications

(65 reference statements)

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“…Consideration of the healing of a surgical site is also important when planning reconstruction. 14 Our patient had a clinical course complicated by infection and the eventual autoamputation of the tip of her nose, which is unlike the typical clinical scenario where lesions heal without any permanent damage. This has been reported with other patients, most commonly those with infections.…”

Section: E134mentioning

confidence: 71%

“…1,2 Additionally, it has been proposed that levamisole in combination with an HLA genotype may induce autoantibody formation, increase metabolism of levamisole to a thiazole derivative, or cause an immune-mediated delayed type hypersensitivity reaction, where levamisole or its metabolites form a hapten with a self-antigen and induce T-cell activation. 14 Due to its immunomodulatory effects, levamisole may also unmask an autoimmune disease. 5,13 The route of cocaine ingestion does not appear to play a role in the development of LAC-induced pathology.…”

Section: E134mentioning

confidence: 99%

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Levamisole-Adulterated Cocaine Induced Skin Necrosis of Nose, Ears, and Extremities: Case Report

Lawrence

Jiron

Lin

et al. 2014

Allergy�Rhinol (Providence)

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Levamisole is an immunomodulatory and antihelminthic drug, previously removed from the United States market, and now estimated to be present in the vast majority of cocaine distributed in the United States. Levamisole-adulterated cocaine (LAC) exposure can result in neutropenia, thrombocytopenia, and vasculitis with a predilection for subsites of the face. The objective of this review is to increase awareness among otolaryngologists of the manifestations of LAC exposure. We present the case of a 33-year-old woman with a history of cocaine use, consulted for purpuric, necrotic lesions of the nose, cheeks, and ears, with accompanying leukopenia, thrombocytopenia, and positive antineutrophil cytoplasmic antibodies (ANCA). The effects of levamisole are immune mediated, with antibodies directed against neutrophils causing neutropenia, and vasculitis caused by antibody deposition or secondary to induction of antiphospholipid antibodies causing thrombosis. LAC exposure can be differentiated from other similar appearing pathologies by evaluating serology for specific ANCA. The most important treatment is cessation of cocaine use, which most often results in complete resolution of symptoms. Awareness of the presentation, complications, and treatment of LAC exposure may be especially important for otolaryngologists, who may be one of the firsts to evaluate an affected patient.

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Section: E134mentioning

confidence: 71%

Section: E134mentioning

confidence: 99%

Levamisole-Adulterated Cocaine Induced Skin Necrosis of Nose, Ears, and Extremities: Case Report

Lawrence

Jiron

Lin

et al. 2014

Allergy�Rhinol (Providence)

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“…La cocaïne, disponible sur le marché français, est le plus souvent combinée à des produits adultérants comme la phénacétine (précurseur du paracétamol, retiré du marché depuis les années 1980), du levamisole, des anesthésiques locaux comme la lidocaïne ou la procaïne. Le levamisole a été incriminé dans la survenue de complications hématologiques comme l'agranulocytose [19] ou la neutropénie [20] et de complications dermatologiques [21] avec nécroses cutanées [22,23].…”

Section: Données Cliniquesunclassified

Addiction aux drogues stimulantes (cocaïne, méthamphétamine et nouveaux produits de synthèse)

Karila

Lejoyeux

2014

Réanimation

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Les drogues stimulantes font partie du nouveau paysage des addictions. À un niveau mondial, la cocaïne est devenue très présente sur la scène des drogues en l'espace de quelques années, même si le cannabis reste au sommet des consommations. Les stimulants de synthèse que sont les amphétamines et la méthamphétamine sont fabriqués en Europe pour une consommation domestique. Sous la dénomination d'euphorisants légaux, les nouveaux produits de synthèse ont fait une percée considérable sur le marché des drogues depuis 2008. Ces substances psychoactives ont des caractéristiques cliniques communes mais également des différences singulières. Elles sont à l'origine de complications somatiques, psychiatriques et sociales. La prise en charge doit être multimodale et la recherche, encore balbutiante dans ce domaine, doit se poursuivre.Mots clés Cocaïne · Nouveau produit de synthèse · Drogue stimulante · Crack · Free base · Cathinone de synthèse · Méthamphétamine · Addiction Abstract Stimulant drugs are a part of the new landscape of addiction. At a global level, cocaine became very present on the drug scene within a few years, although cannabis consumption remains at the top. The synthetic stimulants including amphetamines and methamphetamine are manufactured in Europe for domestic consumption. New synthetic products, called legal highs, have made considerable headway in the drug market since 2008. These psychoactive substances are responsible for common clinical features with singular differences. Their consumption may result in somatic, psychiatric and social complications. Management should be multimodal and research, still preliminary in this field, must continue.

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“…Illicit drug manufacturers have begun to adulterate cocaine with levamisole. The later is quickly metabolized into aminorex (25,30), which in turn causes clonic seizures, and sometimes serotonin syndrome, not to mention cutaneous vasculopathy, a disease that is being reported with ever greater frequency (31)(32)(33)(34)(35). Even worse, chronic exposure to aminorex can cause pulmonary hypertension (36).…”

Section: Neurochemical Mechanismsmentioning

confidence: 99%

Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome

Karch

2012

Academic Forensic Pathology

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Excited Delirium Syndrome (ExDS) is a term traditionally used in forensic literature to describe the symptoms and signs seen in a subgroup of patients with delirium who die in an agitated state. Components of this syndrome are altered mental status, combativeness and/or aggressiveness, increased tolerance to significant pain, tachypnea, profuse sweating, severe agitation, elevated temperature, delirium, and noncompliance with law enforcement and medical personnel. The individual may display "superhuman" strength and wear clothing inappropriate for the environment. Patients with this presentation are almost guaranteed to cause difficulties for law enforcement officers and medical staff. This review is written in hopes of minimizing some of these difficulties by 1) increasing general awareness and specific knowledge about this condition, 2) explaining the neurochemical and neuroanatomical alterations that have been shown to cause those symptoms, and 3) by suggesting new lines of research that might identify easily measured biomarkers for the disease. If the disease mechanism can be deciphered, then it should be possible to devise effective strategies for treatment. It would also be of enormous value to the legal system. When defending a diagnosis before the court, physical evidence always trumps knowledge and experience. It would be far better to be able to present physical proof than to opine that the decedent's behavior was typical for the disease. In this aspect, ExDS is analogous to myocardial infarction: if a man dies suddenly, it is much easier to prove the cardiac origin of the event if an occlusive thrombus is found in a major coronary artery.

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Levamisole‐induced occlusive necrotising vasculitis in cocaine abusers: an unusual cause of skin necrosis and neutropenia

Cited by 19 publications

References 44 publications

Levamisole-Adulterated Cocaine Induced Skin Necrosis of Nose, Ears, and Extremities: Case Report

Levamisole-Adulterated Cocaine Induced Skin Necrosis of Nose, Ears, and Extremities: Case Report

Addiction aux drogues stimulantes (cocaïne, méthamphétamine et nouveaux produits de synthèse)

Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome

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