title: The head, neck, and systemic manifestations of levamisole-adulterated cocaine use.
abstract: Systemic complications of levamisole-adulterated cocaine (LAC) use have recently been described. The objective of this review is to increase awareness of these manifestations among oral and maxillofacial surgeons. LAC exposure through inhalation, nasal insufflation, or injection can induce cutaneous vasculopathy and hematologic abnormalities such as neutropenia or agranulocytosis. Unlike other vasculopathies involving the skin, LAC-induced vascular injury frequently manifests with purpuric and necrotic lesions that involve the face and ears. Oral manifestations have also been reported but are not yet well characterized. The aforementioned hematologic manifestations are not uncommon, and patients exposed to LAC are potentially at higher risk for infectious complications. When manifestations of LAC affect the head, neck, and oral cavity, oral and maxillofacial surgeons may be the first providers to encounter the patient. Early recognition of the clinical signs and laboratory abnormalities will better allow for distinguishing LAC-related effects from various clinical mimics, will facilitate appropriate patient management, and may further contribute to the understanding of the biological effects of LAC.
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA. cottrk@hotmail.com
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Magliocca
authors.forename: Neysa Alice
authors.initials: NA
authors.lastname: Coker
authors.forename: Sareeta R
authors.initials: SR
authors.lastname: Parker
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced*; D018771:Arthralgia / Q000139:chemically induced; D001323:Autoantibodies; D003042:Cocaine / Q000737:chemistry; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000473:pathology; D004340:Drug Contamination; D004431:Ear, External / Q000098:blood supply; D005145:Face / Q000098:blood supply; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D009059:Mouth Diseases / Q000139:chemically induced; D009333:Neck / Q000098:blood supply; D009668:Nose Diseases / Q000139:chemically induced; D016155:Oral Fistula / Q000139:chemically induced; D011693:Purpura / Q000139:chemically induced*
chemical_list: D001323:Autoantibodies; D007978:Levamisole; D003042:Cocaine