Old drug new trick: levamisole-adulterated cocaine causing acute kidney injury

Ammar, Abeer T.; Livak, M.; Witsil, Joanne C.

doi:10.1016/j.ajem.2014.08.015

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…Dermatological manifestations may include fixed drug eruptions, lichen planus, ulceration, nodules, erythema nodosum leprosum, nonspecific maculopapular rashes, and hemorrhagic bullae [18,20]. The characteristic lesions are rapidly progressive cutaneous ecchymoses, raised purpura, and bullae resulting in a distinct stellate lesion with erythematous borders and a necrotic center, which have a predilection for the ears and cheeks (Figures 2 and 3) [18,20,21]. In addition to the dermatological manifestations, agranulocytosis, leukoencephalopathy, and acute kidney injury (suspected to be from renal tubular necrosis) can also be caused by levamisole [21].…”

Section: Skin and Soft-tissue Infections And Manifestationsmentioning

confidence: 99%

“…The characteristic lesions are rapidly progressive cutaneous ecchymoses, raised purpura, and bullae resulting in a distinct stellate lesion with erythematous borders and a necrotic center, which have a predilection for the ears and cheeks (Figures 2 and 3) [18,20,21]. In addition to the dermatological manifestations, agranulocytosis, leukoencephalopathy, and acute kidney injury (suspected to be from renal tubular necrosis) can also be caused by levamisole [21]. Most patients with complications from levamisole have autoantibodies, including but not limited to pANCA, cANCA, anticardiolipin, antinuclear antibody, and anti-double-stranded DNA [20].…”

Section: Skin and Soft-tissue Infections And Manifestationsmentioning

confidence: 99%

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Emerging and Underrecognized Complications of Illicit Drug Use

et al. 2015

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Illicit drug use can result in a wide range of medical complications. As the availability, synthesis, and popularity of illicit drugs evolve over time, new syndromes associated with their use may mimic infections. Some of these symptoms are anticipated drug effects, and others are complications of adulterants mixed with drugs or complications from the method of using drugs. Some illicit drugs are associated with rare infections, which are difficult to diagnosis with standard microbiological techniques. The goal of this review is to orient a wide range of clinicians-including general practitioners, emergency medicine providers, and infectious diseases specialists-to complications of illicit drug use that may be underrecognized. Improving awareness of infectious and noninfectious complications of illicit drug can expedite diagnosis and medical treatment of persons who use drugs and facilitate targeted harm reduction counseling to prevent future complications.

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Section: Skin and Soft-tissue Infections And Manifestationsmentioning

confidence: 99%

Section: Skin and Soft-tissue Infections And Manifestationsmentioning

confidence: 99%

Emerging and Underrecognized Complications of Illicit Drug Use

et al. 2015

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“…Levamisole is a common adulterant of cocaine that may lead to leukoencephalopathy, agranulocytosis, or cutaneous vasculitis. Levamisole-induced vasculitis and AKI have been reported in a few cases [6].…”

Section: Discussionmentioning

confidence: 99%

Cocaine and Alcohol Co-Ingestion-Induced Severe Rhabdomyolysis With Acute Kidney Injury Culminating in Hemodialysis-Dependent End-Stage Renal Disease: A Case Report and Literature Review

Roy

Konala

Adapa

et al. 2020

Cureus

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Cocaine toxicity is associated with several organ dysfunctions, including acute kidney injury (AKI). Rhabdomyolysis is the most likely mechanism that mediates AKI, and associated alcohol co-ingestion can amplify the situation. AKI, if severe, can result in end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). All patients with cocaine intoxication should be screened for rhabdomyolysis and AKI along with testing for other drug toxicity, including alcohol. Aggressive measures should be taken to treat the underlying cause that contributes to AKI, and the patients need to be educated about this severe condition. Our patient is a unique case where cocaine and alcohol co-ingestion led to severe rhabdomyolysis, AKI, and subsequently developed ESRD requiring ongoing hemodialysis (HD). He was on daily cocaine and alcohol coingestion for seven days and subsequently developed AKI with oliguria from rhabdomyolysis. His creatine kinase (CK) was significantly elevated to 141974 IU/L, and his serum creatinine was 11 mg/dl. Despite aggressive intravenous hydration, his kidney function did not improve, and he ended up needing HD for more than one year despite abstaining from cocaine.

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“…Usually, this is associated with myeloperoxidase (MPO) and proteinase-3 (PR3) antibodies. In addition, antinuclear antibody (ANA), lupus anticoagulant and low complement levels are detected in most patients [ 70 – 76 ]. Immune complex glomerulonephritis (GN) has been described but in such case, an underlying infection should always be considered [ 20 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic review of nephrotoxicity of drugs of abuse, 2005–2016

et al. 2017

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BackgroundThe United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes.MethodsWe conducted a systematic review of published case reports, case series, and cross sectional studies of nephrotoxicities related to drugs of abuse. Literature review was conducted using PubMed/Medline from January 1, 2005 -December 31, 2016 to search for publications related to drug abuse with a defined renal outcome. Publications which reported renal injury in relation to the use of illicit drugs were selected, specifically those cases with raised creatinine levels, clinically symptomatic patients, for instance those with oliguria and proven renal biopsies.ResultsA total of 4798 publications were reviewed during the search process and PRISMA flow chart and Moose protocol regarding systematic reviews were followed. 110 articles were shortlisted for the review. A total of 169 cases from case reports and case series, and 14 case studies were analyzed. Renal manifestations of specific illicit drug abuse were included in this review.ConclusionBased on the evidence presented, a wide range of renal manifestations were found to be associated with drug abuse. If the trend of increasing use of illicit drug use continues, it will put a significant percentage of the population at an elevated risk for poor renal outcomes. This study is limited by the nature of the literature reviewed being primarily case reports and case series.

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Old drug new trick: levamisole-adulterated cocaine causing acute kidney injury

Cited by 14 publications

References 7 publications

Emerging and Underrecognized Complications of Illicit Drug Use

Emerging and Underrecognized Complications of Illicit Drug Use

Cocaine and Alcohol Co-Ingestion-Induced Severe Rhabdomyolysis With Acute Kidney Injury Culminating in Hemodialysis-Dependent End-Stage Renal Disease: A Case Report and Literature Review

Systematic review of nephrotoxicity of drugs of abuse, 2005–2016

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