title: Levamisole induced necrosis of the skin and neutropenia following intranasal cocaine use: a newly recognized syndrome.
abstract: Levamisole is a veterinary anti-helminthic used to treat several autoimmune conditions but also commonly utilized as an additive in cocaine distribution. Toxicity resulting in agranulocytosis and cutaneous necrosis in association with cocaine use is an infrequently described phenomenon of an emerging problem. Although levamisole is found extensively in the cocaine supply of the United States, relatively few cases of necrotic skin lesions associated with intranasal use have been reported. The skin necrosis secondary to levamisole toxicity is characterized by variable findings on biopsy, ranging from leukocytoclastic vasculitis to occlusive vasculopathy. The following case describes a 54-year-old male who developed fever, agranulocytosis, p-ANCA autoantibodies and extensive skin necrosis following heavy intranasal cocaine use. Necrosis of greater than 50% of the patient's total body surface area resulted and was followed by thorough wound debridement.
authors.affiliation: University of South Florida College of Medicine, FL 33601-1289, USA.
authors.forename: John
authors.initials: J
authors.lastname: Mouzakis
authors.forename: Charurut
authors.initials: C
authors.lastname: Somboonwit
authors.forename: Seetha
authors.initials: S
authors.lastname: Lakshmi
authors.forename: Mark
authors.initials: M
authors.lastname: Rumbak
authors.forename: John
authors.initials: J
authors.lastname: Sinnott
authors.forename: Basil
authors.initials: B
authors.lastname: Cherpelis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Keshishian
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology; D003042:Cocaine / Q000737:chemistry / Q000592:standards; D019970:Cocaine-Related Disorders / Q000150:complications*; D004340:Drug Contamination; D005334:Fever / Q000139:chemically induced; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000139:chemically induced; D009503:Neutropenia / Q000139:chemically induced*; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D014481:United States
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007978:Levamisole; D003042:Cocaine