title: [Agranulocytosis and vasculitis in a cocaine addict: levamisole, the hidden culprit].
abstract: BACKGROUND
  Adulterants are compounds added to street drugs to increase profits for the seller. Levamisole, a veterinary antihelminthic agent, has become the most common adulterant of cocaine. The prevalence of levamisole in samples of cocaine is increasing. Levamisole can lead to neutropenia and to a dramatic vasculopathy and even vasculitis of small and medium-size blood vessels.
  
  
  METHODS
  We here reported the first French case of levamisole related toxicity, due to cocaine use in a 50-year-old man, revealed by fever and agranulocytosis, high titters of antineutrophil cytoplasmic antibodies (ANCA), anticoagulant and positive Coombs tests. Outcome was slowly favorable with exposition withdrawal.
  
  
  CONCLUSIONS
  Clinicians should be aware that agranulocytosis or vasculitis or vasculopathy could be related to levamisole toxicity in individuals who use cocaine.
authors.affiliation: Service de médecine interne, hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Lemaignen
authors.affiliation: Service de médecine interne, hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. Electronic address: tiphaine.goulenok@bjn.aphp.fr.
authors.forename: T
authors.initials: T
authors.lastname: Goulenok
authors.affiliation: Unité de traitement ambulatoire des maladies addictives (UTAMA), hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: S
authors.initials: S
authors.lastname: Kalamarides
authors.affiliation: Unité de traitement ambulatoire des maladies addictives (UTAMA), hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Plat
authors.affiliation: Dispositif TREND/SINTES Paris, association Charonne, 75012 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Pfau
authors.affiliation: Service de médecine interne, hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: B
authors.initials: B
authors.lastname: Fantin
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D019970:Cocaine-Related Disorders / Q000150:complications*; D004340:Drug Contamination; D055030:Drug Users; D006801:Humans; D007978:Levamisole / Q000506:poisoning*; D008297:Male; D008875:Middle Aged; D014657:Vasculitis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis
chemical_list: D007978:Levamisole
keywords: Cocaine; Cocaïne; Levamisole; Lévamisole; Neutropenia; Neutropénie; Vascularite; Vasculopathy