Levamisole toxicity: Difference between revisions
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==Background== | ==Background== | ||
* | *An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects | ||
*Increasingly used as a cutting agent in cocaine sold around the globe | *Increasingly used as a cutting agent in cocaine sold around the globe | ||
**69% of DEA seized cocaine contained levamisole (2009)<ref> Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref> | |||
*Results in Levamisole induced necrosis syndrome<ref>http://www.ncbi.nlm.nih.gov/pubmed/20668440</ref> | *Results in Levamisole induced necrosis syndrome<ref>http://www.ncbi.nlm.nih.gov/pubmed/20668440</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
* | [[File:PMC4456982 amjcaserep-16-310-g002.png|thumb|Leviamisole induced retiform purpura with hemorrhagic bullae in a patient with cocaine abuse<ref>Cocaine-induced delayed recurrent vasculitis: a 4-year follow-up. | ||
**neutropenia | Yogarajah M, Pervil-Ulysse M, Sivasambu B - Am J Case Rep (2015)</ref>]] | ||
* | *Agranulocytosis/Thrombocytopenia | ||
**Typically neutropenia | |||
**Tends to reverse spontaneously when discontinued | |||
*Levamisole induced necrosis syndrome | |||
**Necrotic patches anywhere on skin (especially ears and legs) | **Necrotic patches anywhere on skin (especially ears and legs) | ||
*Leukoencephalopathy | |||
**Seen when used as a pharmaceutical in past | |||
**No cases described when associated with cocaine adulteration | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Necrotizing Rashes DDX}} | |||
== | ==Evaluation== | ||
*CBC | *CBC | ||
| Line 22: | Line 30: | ||
**Aggressive supportive care | **Aggressive supportive care | ||
**Burn care if significant necrosis | **Burn care if significant necrosis | ||
*Avoid cocaine re-exposure | |||
**27% of patients had symptom recurrence with cocaine re-exposure<ref>Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234</ref> | |||
==Disposition== | ==Disposition== | ||
Admission | *Admission | ||
==See Also== | ==See Also== | ||
*[[Cocaine]] | *[[Cocaine]] | ||
*[[Drug rash]] | |||
==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Toxicology]] | ||
Revision as of 05:34, 1 February 2019
Background
- An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects
- Increasingly used as a cutting agent in cocaine sold around the globe
- 69% of DEA seized cocaine contained levamisole (2009)[1]
- Results in Levamisole induced necrosis syndrome[2]
Clinical Features
Leviamisole induced retiform purpura with hemorrhagic bullae in a patient with cocaine abuse[3]
- Agranulocytosis/Thrombocytopenia
- Typically neutropenia
- Tends to reverse spontaneously when discontinued
- Levamisole induced necrosis syndrome
- Necrotic patches anywhere on skin (especially ears and legs)
- Leukoencephalopathy
- Seen when used as a pharmaceutical in past
- No cases described when associated with cocaine adulteration
Differential Diagnosis
Necrotizing rashes
- Necrotizing soft tissue infections
- Purpura fulminans
- Drug rash
- Levamisole toxicity
- Heparin-induced skin necrosis
- Warfarin-induced skin necrosis
Evaluation
- CBC
Management
- Neutropenia
- Consider neupogen
- Observation for neutropenic fever
- Necrosis
- Aggressive supportive care
- Burn care if significant necrosis
- Avoid cocaine re-exposure
- 27% of patients had symptom recurrence with cocaine re-exposure[4]
Disposition
- Admission
See Also
External Links
References
- ↑ Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234
- ↑ http://www.ncbi.nlm.nih.gov/pubmed/20668440
- ↑ Cocaine-induced delayed recurrent vasculitis: a 4-year follow-up. Yogarajah M, Pervil-Ulysse M, Sivasambu B - Am J Case Rep (2015)
- ↑ Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234