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Cocaine-levamisole thrombotic vasculopathy.
1Department of Hematology and Oncology, St. Luke's Roosevelt Hospital Center, New York, New York 10019, USA. irenedymd@yahoo.com
Seminars in Thrombosis and Hemostasis
|October 9, 2012
Summary
Cocaine adulterated with levamisole can cause a serious condition called cocaine-levamisole thrombotic vasculopathy, characterized by skin issues, joint pain, low white blood cell count, and ANCA antibodies.
Area of Science:
- Toxicology
- Dermatology
- Rheumatology
Background:
- Cocaine is frequently adulterated with levamisole to enhance its psychoactive effects.
- Levamisole, an antihelminthic drug, is associated with severe adverse reactions when used as a cocaine adulterant.
- These reactions include fatal agranulocytosis, flu-like symptoms, and a distinct thrombotic vasculopathy.
Purpose of the Study:
- To review the toxicities associated with levamisole, a common cocaine adulterant.
- To specifically focus on the prothrombotic effects leading to cocaine-levamisole thrombotic vasculopathy.
- To emphasize the importance of a high index of suspicion for diagnosing this syndrome.
Main Methods:
- Review of existing literature on cocaine-levamisole thrombotic vasculopathy.
- Analysis of reported cases and clinical manifestations.
- Examination of the pathophysiological mechanisms underlying the prothrombotic state.
Main Results:
- Cocaine-levamisole thrombotic vasculopathy presents as a tetrad of cutaneous manifestations, arthralgia, leukopenia, and positive antineutrophil cytoplasmic antibodies (ANCA).
- Levamisole's adverse effects contribute significantly to the development of this vasculopathy.
- The prothrombotic nature of the syndrome poses a significant clinical challenge.
Conclusions:
- Cocaine-levamisole thrombotic vasculopathy is a serious condition requiring prompt recognition.
- Understanding levamisole's toxicities, particularly its prothrombotic effects, is crucial for diagnosis and management.
- A high index of suspicion is essential for identifying patients affected by this drug-induced vasculopathy.
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