title: Aminorex associated with possible idiopathic pulmonary hypertension in a cocaine user.
abstract: The conversion of levamisole to aminorex in horses was first described in 2009 and, for the first time, confirmed in humans two years later by our laboratory. Aminorex and levamisole interfere with serotonin metabolism and both are proven cause of potentially fatal idiopathic pulmonary hypertension (IPH). Because most of the world's seizures of illicit cocaine is now contaminated with levamisole, this raises the possibility that users of levamisole adulterated cocaine users may be at risk for IPH. Here we describe the first case of IPH in a user of levamisole-contaminated cocaine. Levamisole and aminorex were both identified and quantified in hair and other biological specimens by means gas chromatography/mass spectrometry system (levamisole: urine, 75.05ng/mL; blood, 15.05ng/mL; brain, >0.15ng/g; liver, >0.15ng/g; hair, 12.15ngmg; aminorex: urine, 38.62ng/mL; blood, 8.92ng/mL, brain >0.15ng/g; liver, 0.15ng/g; hair 7.35ng/mg; cocaine, benzoylecgonine, morphine, 6-acetylmorphine, methadone, 2-ethylidine-1, 5-dimetil-3, 3 diphenylpyrrolidine were also detected). Moreover histological changes associated with IPH were observed in the lung. As IPH produces relatively non-specific symptoms in its early stages, this index case may serve as a harbinger of many more cases to come. It should also alert clinicians to the possibility that their patient may be suffering from this relatively rare disorder.
authors.affiliation: Consultant Pathologist/Toxicologist, Berkeley, CA, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Karch
authors.affiliation: Division of Legal Medicine, Department of Health Sciences, University of Florence, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Defraia
authors.affiliation: Division of Human Pathology, University of Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Messerini
authors.affiliation: Division of Forensic Toxicology, Department of Health Sciences, University of Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mari
authors.affiliation: Division of Forensic Toxicology, Department of Health Sciences, University of Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Vaiano
authors.affiliation: Division of Forensic Toxicology, Department of Health Sciences, University of Florence, Italy. Electronic address: elisabetta.bertol@unifi.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bertol
mesh_terms: D000635:Aminorex / Q000009:adverse effects* / Q000032:analysis; D001067:Appetite Depressants / Q000009:adverse effects* / Q000032:analysis; D019970:Cocaine-Related Disorders / Q000150:complications*; D055030:Drug Users; D049429:Forensic Pathology; D006197:Hair / Q000737:chemistry; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced*; D007978:Levamisole / Q000032:analysis; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D001067:Appetite Depressants; D007978:Levamisole; D000635:Aminorex
keywords: Aminorex; Cocaine; IPH risk; Levamisole adulteration