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Levamisole toxicity
From WikEM
Contents
Background
- An antihelminthic and immunomodulator that has been withdrawn from the U.S. and Canadian markets, due to the risk of serious side effects
- Increasingly used as a cutting agent in cocaine sold around the globe
- 69% of DEA seized cocaine contained levamisole (2009)[1]
- Results in Levamisole induced necrosis syndrome[2]
Clinical Features
- Agranulocytosis/Thrombocytopenia
- Typically neutropenia
- Tends to reverse spontaneously when discontinued
- Levamisole induced necrosis syndrome
- Necrotic patches anywhere on skin (especially ears and legs)
- Leukoencephalopathy
- Seen when used as a pharmaceutical in past
- No cases described associated with cocaine adulteration
Differential Diagnosis
Necrotizing rashes
- Necrotizing soft tissue infections
- Purpura fulminans
- Drug rash
- Levamisole toxicity
Evaluation
- CBC
Management
- Neutropenia
- Consider neupogen
- Observation for neutropenic fever
- Necrosis
- Aggressive supportive care
- Burn care if significant necrosis
- Avoid cocaine re-exposure
- 27% of patients had symptom recurrence with cocaine re-exposure[3]
Disposition
Admission
See Also
External Links
References
- ↑ Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234
- ↑ http://www.ncbi.nlm.nih.gov/pubmed/20668440
- ↑ Larocque, L. Hoffman, R. Clinical Toxicology: Levamisole in cocaine: Unexpected news from an old acquaintance. (2012), 50, 231-234
