title: Levamisole-induced Necrosis Syndrome: Presentation and Management.
abstract: Levamisole is an antihelminthic drug with immunomod- ulatory properties. Recent estimates suggest the majority of the cocaine in the United States is adulterated with levamisole. Le- vamisole-induced necrosis syndrome (LINES) is characterized by vasculitis, neutropenia, and purpura that progresses to skin necro- sis. Diagnosis relies on physical examination ndings and history of previous cocaine use. The purpose of this case series is to describe the pathophysiology, diagnosis, and management of LINES. The au- thors' institutional database was reviewed from 2008 to 2015, and they found 3 patients with LINES. Subsequent management and outcomes data are discussed. Patients had a variety of outcomes ranging from local wound care to necrosis and amputation of pha- langes. Patients with LINES can have a wide variety of outcomes; thus, this syndrome must be aggressively managed. Psychotherapy should also be utilized to help patients with further cocaine use. Levamisole-induced necrosis syndrome incidence is expected to in- crease, and all providers should be aware of this patient population.
authors.affiliation: Department of General Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Charles
authors.initials: C
authors.lastname: Fredericks
authors.affiliation: Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
authors.forename: James R
authors.initials: JR
authors.lastname: Yon
authors.affiliation: Department of General Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Gillian
authors.initials: G
authors.lastname: Alex
authors.affiliation: Department of General Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Molly
authors.initials: M
authors.lastname: Morton
authors.affiliation: Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
authors.forename: Thomas
authors.initials: T
authors.lastname: Messer
authors.affiliation: Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
authors.forename: Faran
authors.initials: F
authors.lastname: Bokhari
authors.affiliation: Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL.
authors.forename: Stathis
authors.initials: S
authors.lastname: Poulakidas
mesh_terms: D000328:Adult; D001830:Body Surface Area; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000628:therapy*; D003646:Debridement / Q000379:methods*; D004340:Drug Contamination; D005260:Female; D006801:Humans; D007978:Levamisole / Q000009:adverse effects* / Q000493:pharmacokinetics; D009336:Necrosis / Q000139:chemically induced* / Q000628:therapy; D009779:Occlusive Dressings; D017410:Practice Guidelines as Topic; D017445:Skin Diseases, Vascular / Q000139:chemically induced* / Q000628:therapy; D013577:Syndrome; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D007978:Levamisole; D003042:Cocaine