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[Agranulocytosis and vasculitis in a cocaine addict: levamisole, the hidden culprit]
A Lemaignen1, T Goulenok1, S Kalamarides2
1Service de médecine interne, hôpital Beaujon, université Paris Diderot, Sorbonne Paris-Cité, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
Introduction:
Adulterants are compounds added to street drugs to increase profits for the seller. Levamisole, a veterinary antihelminthic agent, has become the most common adulterant of cocaine. The prevalence of levamisole in samples of cocaine is increasing. Levamisole can lead to neutropenia and to a dramatic vasculopathy and even vasculitis of small and medium-size blood vessels.
Case Report:
We here reported the first French case of levamisole related toxicity, due to cocaine use in a 50-year-old man, revealed by fever and agranulocytosis, high titters of antineutrophil cytoplasmic antibodies (ANCA), anticoagulant and positive Coombs tests. Outcome was slowly favorable with exposition withdrawal.
Conclusion:
Clinicians should be aware that agranulocytosis or vasculitis or vasculopathy could be related to levamisole toxicity in individuals who use cocaine.
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