title: Susac-like syndrome in a chronic cocaine abuser: could levamisole play a role?
abstract: BACKGROUND
  Toxic leukoencephalopathy is a possible but rare complication of chronic cocaine abuse. The role of adulterants, mainly levamisole, is still debated.
  
  
  METHODS
  We describe an atypical case of fatal leukoencephalopathy mimicking Susac syndrome in a 22-year-old man who was chronically abusing cannabis and cocaine. Exposure to levamisole as adulterant to cocaine was proven by hair analysis. Despite cessation of exposure to cocaine and aggressive immunosuppressive therapy, the patient remained in a minimally conscious state until death.
  
  
  CONCLUSIONS
  Susac syndrome is a rare entity, and its etiology is not yet fully elucidated. The toxic etiologies have been poorly investigated to date. Further observations are required to determine if cocaine and/or adulterants might play a significant role.
authors.affiliation: Louvain Centre for Toxicology and Applied Pharmacology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium, philippe.hantson@uclouvain.be.
authors.forename: P
authors.initials: P
authors.lastname: Hantson
authors.forename: V
authors.initials: V
authors.lastname: Di Fazio
authors.forename: M
authors.initials: M
authors.lastname: Del Mar Ramirez Fernandez
authors.forename: N
authors.initials: N
authors.lastname: Samyn
authors.forename: T
authors.initials: T
authors.lastname: Duprez
authors.forename: V
authors.initials: V
authors.lastname: van Pesch
mesh_terms: D000328:Adult; D001259:Ataxia / Q000209:etiology; D003042:Cocaine / Q000737:chemistry* / Q000633:toxicity; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004340:Drug Contamination; D017809:Fatal Outcome; D006197:Hair / Q000737:chemistry; D006261:Headache / Q000209:etiology; D006801:Humans; D013287:Illicit Drugs / Q000737:chemistry* / Q000633:toxicity; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007978:Levamisole / Q000032:analysis / Q000633:toxicity*; D008297:Male; D002189:Marijuana Abuse / Q000150:complications; D010292:Paresthesia / Q000209:etiology; D015813:Substance Abuse Detection; D055955:Susac Syndrome / Q000175:diagnosis; D055815:Young Adult
chemical_list: D013287:Illicit Drugs; D007978:Levamisole; D003042:Cocaine