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* | *An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects | ||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> | **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> | ||
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==Clinical Features== | ==Clinical Features== | ||
* | *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 associated with cocaine adulteration | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 19:47, 21 June 2016
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- An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects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
- 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 associated with cocaine adulteration
Differential Diagnosis
Workup
- 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[3]
Disposition
Admission
See Also
External Links
Sources
- ↑ 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
- ↑ Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234