Levamisole-Adulterated Cocaine Toxicity: Would You Recognize It?
Adulteration of cocaine with levamisole is common and can induce serious medical complications. Levamisole is an antihelminthic agent originally approved as an immunomodulator in the treatment of autoimmune disorders and as a chemotherapy adjunct. It was withdrawn from the US market in 2000 but is available in veterinary medicine. Cocaine-using patients may present with nonspecific constitutional symptoms, cutaneous eruptions, leukopenia, vasculitis, and organ damage. Skin manifestations may include severe necrosis, especially of the ear lobes. Here, a case of levamisole toxicity is presented and treatment options are discussed.
Department of Psychiatry, MetroHealth Medical Center, Cleveland, Ohio, USA.
Suneela
S
Cherlopalle
Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Manasa
M
Enja
Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Melanie
M
Lippmann
University of Louisville School of Medicine, 401 E Chestnut St, Ste 610, Louisville, KY 40202. sblipp01@louisville.edu.|Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Steven
S
Lippmann
D000328:Adult; D000969:Antinematodal Agents / Q000506:poisoning*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000175:diagnosis*; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007978:Levamisole / Q000506:poisoning*; D063806:Myalgia / Q000139:chemically induced / Q000175:diagnosis
D000969:Antinematodal Agents; D007978:Levamisole