Treatment of rheumatoid arthritis with levamisole: long-term results and immune changes.

Runge, Lorne A.; Pinals, Robert S.; Tomar, Russell H.

doi:10.1136/ard.38.2.122

Cited by 19 publications

(1 citation statement)

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“…It was initially reported as an idiosyncratic reaction in patients treated with levamisole for rheumatoid arthritis. Later, patients developing neutropenia with levamisole were shown to be positive for HLA-B27 genotype [ 7 ]. Agranulocytosis also more commonly occurs in females and in smokers of crack cocaine.…”

Section: Discussionmentioning

confidence: 99%

Agranulocytosis – Sequelae of Chronic Cocaine Use: Case Series and Literature Review

Srivastava

Rizwan

Jamil

et al. 2017

Cureus

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Agranulocytosis is a rare condition with a reported incidence ranging from one to five cases per million population per year. Most commonly, agranulocytosis is secondary to chemotherapeutic agents, however, other medications have also been associated with it. An immune mediated destruction of circulating granulocytes and/or granulocyte precursors secondary to drug-dependent or drug-induced antibodies is the postulated mechanism. Agranulocytosis has also been reported secondary to recreational drug use. Cocaine is one of the most commonly used recreational drugs and is often laced with Levamisole to enhance its psychostimulatory properties. Levamisole is an immune modulator and can cause bone marrow suppression. It can be detected in urine by gas chromatography-mass spectrometry.We report two cases of recurrent agranulocytosis in non-oncology patients secondary to chronic cocaine abuse, who were treated with granulocyte colony-stimulating factor (GCSF) and broad spectrum antibiotics without sustained response.The high prevalence of cocaine use continues to be a serious public health concern. This case series discusses the association of adulterated cocaine as an etiology of unexplained neutropenia and highlights the diverse clinical complications of chronic cocaine abuse. Currently, the available literature is reviewed.

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Section: Discussionmentioning

confidence: 99%