Semin Thromb Hemost 2012; 38(08): 780-782
DOI: 10.1055/s-0032-1328889
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cocaine-Levamisole Thrombotic Vasculopathy

Irene A. Dy
1   Department of Hematology and Oncology, St. Luke's Roosevelt Hospital Center, New York, New York
2   Continuum Cancer Centers of New York, New York, New York
,
Peter H. Wiernik
1   Department of Hematology and Oncology, St. Luke's Roosevelt Hospital Center, New York, New York
2   Continuum Cancer Centers of New York, New York, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
06 October 2012 (online)

Abstract

The syndrome of cocaine-levamisole thrombotic vasculopathy is a tetrad of cutaneous manifestations, arthralgia, leukopenia, and positive antineutrophil cytoplasmic antigen (ANCA). Cocaine is cut with levamisole to potentiate its euphoric effects. However, along with this are the adverse reactions of levamisole such as fatal agranulocytosis, flu-like symptoms, and cutaneous thrombotic vasculopathy. High index of suspicion is needed for its diagnosis. This article will review on its toxicities, especially its prothrombotic effects.

 
  • References

  • 1 Finkel JB, Marhefka GD. Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc 2011; 86 (12) 1198-1207
  • 2 Czuchlewski DR, Brackney M, Ewers C , et al. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010; 133 (3) 466-472
  • 3 Chang A, Osterloh J, Thomas J. Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther 2010; 88 (3) 408-411
  • 4 Scheinfeld N, Rosenberg JD, Weinberg JM. Levamisole in dermatology: a review. Am J Clin Dermatol 2004; 5 (2) 97-104
  • 5 Buchanan JA, Oyer RJ, Patel NR , et al. A confirmed case of agranulocytosis after use of cocaine contaminated with levamisole. J Med Toxicol 2010; 6 (2) 160-164
  • 6 Macfarlane DG, Bacon PA. Levamisole-induced vasculitis due to circulating immune complexes. BMJ 1978; 1 (6110) 407-408
  • 7 Brackney M, Baumbach J, Ewers C , et al. Agranulocytosis associated with cocaine use - four States, March 2008-November 2009. MMWR Morb Mortal Wkly Rep 2009; 58 (49) 1381-1385
  • 8 Zhu NY, Legatt DF, Turner AR. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med 2009; 150 (4) 287-289
  • 9 Poon SH, Baliog Jr CR, Sams RN, Robinson-Bostom L, Telang GH, Reginato AM. Syndrome of cocaine-levamisole-induced cutaneous vasculitis and immune-mediated leukopenia. Semin Arthritis Rheum 2011; 41 (3) 434-444
  • 10 Walsh NMG, Green PJ, Burlingame RW, Pasternak S, Hanly JG. Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole. J Cutan Pathol 2010; 37 (12) 1212-1219
  • 11 Raymon LP, Isenschmid DS. Letter to the editor: the possible role of levamisole in illicit cocaine preparations. J Anal Toxicol 2009; 33 (9) 620-622
  • 12 Erkan D, Zhang HW, Shriky RC, Merrill JT. Dual antibody reactivity to beta2-glycoprotein I and protein S: increased association with thrombotic events in the antiphospholipid syndrome. Lupus 2002; 11 (4) 215-220
  • 13 Wiens MO, Son WK, Ross C, Hayden M, Carleton B. Cases: Cocaine adulterant linked to neutropenia. CMAJ 2010; 182 (1) 57-59
  • 14 Bradford M, Rosenberg B, Moreno J, Dumyati G. Bilateral necrosis of earlobes and cheeks: another complication of cocaine contaminated with levamisole. Ann Intern Med 2010; 152 (11) 758-759