title: [Recurrent neutropenia due to adulterated cocaine].
abstract: BACKGROUND
  Since 2009, a warning has been issued about cocaine that has been adulterated with levamisole, mainly in the USA and Canada. Agranulocytosis occurs as an idiosyncratic reaction in 3-10% of patients exposed to levamisole.
  
  
  METHODS
  A 36-year-old man was referred to our hospital because of an episode of high fever and infections on his hands, mouth and ears. Laboratory testing showed neutropenia. The infections were treated successfully with antibiotics. The neutropenia disappeared, but returned with recurrence of the infections. Upon presentation at the emergency care unit, the patient had signs of intoxication. This patient's urine contained metabolites of cocaine (benzoylecgonine and ecgonine methyl ester), whereupon additional testing showed levamisole to be present in serum. The patient discontinued cocaine use. Following treatment of the infections, the neutropenia fully resolved and did not recur.
  
  
  CONCLUSIONS
  This patient had acquired agranulocytosis, due to the use of cocaine adulterated with levamisole.
authors.affiliation: Onze Lieve Vrouwe Gasthuis, Amsterdam.
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Vos
authors.forename: Eric A F
authors.initials: EA
authors.lastname: Haak
authors.forename: Onno C
authors.initials: OC
authors.lastname: Leeksma
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000175:diagnosis / Q000209:etiology; D003042:Cocaine / Q000031:analogs & derivatives / Q000652:urine; D019970:Cocaine-Related Disorders; D004340:Drug Contamination; D006801:Humans; D007978:Levamisole / Q000009:adverse effects*; D008297:Male; D009503:Neutropenia / Q000139:chemically induced*; D012008:Recurrence
chemical_list: D007978:Levamisole; C005618:benzoylecgonine; D003042:Cocaine; C034524:ecgonine methyl ester