Related Experiment Video
Updated: May 21, 2026
10:28
Assessment of Cocaine-induced Behavioral Sensitization and Conditioned Place Preference in Mice
Published on: February 18, 2016
Cutaneous vasculopathy associated with levamisole-adulterated cocaine
Huy Tran1, Debbie Tan, Thomas P Marnejon
1Internal Medicine Residency Program, Department of Medicine, St. Elizabeth Health Center, Youngstown, OH 44501, USA.
Clinical Medicine & Research
|June 23, 2012
Summary
Levamisole-adulterated cocaine use can cause a unique skin condition. This vasculopathy presents with a rash, low white blood cell count, and positive anti-neutrophilic cytoplasmic antibody (ANCA) tests.
Area of Science:
- Dermatology
- Toxicology
- Immunology
Background:
- Cocaine is frequently adulterated with levamisole, a veterinary dewormer, in the United States.
- Levamisole may enhance cocaine's psychoactive effects and is linked to a distinct clinical syndrome.
Observation:
- A patient presented with a purpuric rash on the ears, leukopenia, and positive anti-neutrophilic cytoplasmic antibody (ANCA).
- Levamisole was confirmed in the patient's urine via gas chromatography-mass spectrometry.
- Skin biopsy revealed vascular thrombosis and necrosis, but not true vasculitis.
Findings:
- The case aligns with the recently described levamisole-adulterated cocaine cutaneous vasculopathy syndrome.
- Key features include characteristic rash, leukopenia, ANCA positivity, and skin necrosis without vasculitis.
- This syndrome is increasingly recognized due to widespread levamisole contamination in cocaine.
Implications:
- Early recognition of this syndrome is crucial for appropriate patient management.
- Distinguishing this entity from idiopathic vasculitis is important for treatment strategies.
- Public health awareness regarding cocaine adulteration is warranted to mitigate associated health risks.
Related Concept Videos
01:16Drug toxicity: Idiosyncratic Reactions
Idiosyncratic drug reactions represent abnormal chemical responses that vary significantly among individuals, ranging from extreme sensitivity to low doses to insensitivity to high doses. These reactions often occur due to the drug's covalent binding with serum proteins, forming a foreign hapten that triggers an immunotoxicological response. The variability in drug reactions has a strong pharmacogenetic foundation, with genetic differences crucial in how individuals metabolize drugs. For...
01:24Drug Toxicity: Risk factors
Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
01:30Drug Toxicity: Allergic Reactions
Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial exposure to a...
01:21Drug Accumulation During Multiple Dosing: Repetitive IV Injections
Calculating drug dosage and accumulation in multiple-dose regimens is crucial for achieving therapeutic efficacy while avoiding toxicity. This involves determining the plasma drug concentrations over time to optimize dosing schedules. The principle of superposition is fundamental in this process, allowing for the prediction of drug concentration in plasma following multiple doses based on single-dose data.The principle of superposition asserts that the plasma concentration-time curves from...
01:00Drug Toxicity: Overview
Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...
01:21Cytotoxic Edema: Pathophysiology
Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous supply...