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. 2012 Jun;87(6):581-6.
doi: 10.1016/j.mayocp.2012.03.010.

Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge

Kachiu C Lee  1 , Barry Ladizinski, Daniel G Federman
Affiliations

Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge

Kachiu C Lee et al. Mayo Clin Proc. 2012 Jun.

Abstract

Levamisole is an immunomodulatory agent that was used to treat various cancers before being withdrawn from the United States market in 2000 because of adverse effects. Levamisole is currently approved as an antihelminthic agent in veterinary medicine, but is also being used illicitly as a cocaine adulterant. Potential complications associated with use of levamisole-laced cocaine include neutropenia, agranulocytosis, arthralgias, retiform purpura, and skin necrosis. Treatment is primarily supportive, and skin lesions typically resolve with cessation of cocaine use. The incidence of hospitalizations related to use of levamisole-contaminated cocaine continues to increase and clinicians should be aware of the more common clinical manifestations.

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Figures

FIGURE 1
FIGURE 1
Left helix with hemorrhagic bullae. Suture on upper ear lobe is biopsy site.
FIGURE 2
FIGURE 2
Nasal tip with necrotic, hemorrhagic crust due to reexposure to levamisole-laced cocaine.
FIGURE 3
FIGURE 3
Algorithm for diagnosis and evaluation of levamisole-induced vasculitis. ANCA = antineutrophil cytoplasmic antibody; +cANCA = ANCA with positive cytoplasmic staining pattern; +pANCA = ANCA with positive perinuclear staining pattern.
See this image and copyright information in PMC

Comment in

  • Levamisole toxicity.
    Graebner RW. Graebner RW. Mayo Clin Proc. 2012 Oct;87(10):1033-4; author reply 1034. doi: 10.1016/j.mayocp.2012.07.010. Mayo Clin Proc. 2012. PMID: 23036678 Free PMC article. No abstract available.

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