Top

Published in:

01-07-2012

Lupus anticoagulant and ANCA associated thrombotic vasculopathy due to cocaine contaminated with levamisole: a case report and review of the literature

Authors: Shuchi Gulati, Anthony A. Donato

Published in: Journal of Thrombosis and Thrombolysis | Issue 1/2012

Abstract

A 2010 US report recently detected the presence of levamisole in greater than 77 % of seized cocaine samples. A syndrome of retiform purpura, often involving ears and flanks, with vasculopathy or vasculitis on biopsy, associated with anti-nuclear cytoplasmic antibodies as well as antiphospholipid antibodies, previously associated with therapeutic use of levamisole has now re-emerged, and is associated with cocaine adulterated with levamisole. Patients with this unusual constellation of signs and laboratory findings should be questioned about exposure to cocaine.

Chang A, Osterloh J, Thomas J (2010) Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther 88(3):408–411PubMedCrossRef

Fucci N (2007) Unusual adulterants in cocaine seized on Italian clandestine market. Forensic Sci Int 172(2–3):e1PubMedCrossRef

Anon. EMCDDA | 2010 Annual report on the state of the drugs problem in Europe. http://www.emcdda.europa.eu/publications/annual-report/2010. Accessed 30 Sept, 2011

Brunt TM, Rigter S, Hoek J et al (2009) An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants. Addiction 104(5):798–805PubMedCrossRef

Zhu NY, Legatt DF, Turner AR (2009) Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Intern Med 150(4):287–289PubMed

Anon. 44849p.pdf. http://www.justice.gov/ndic/pubs44/44849/44849p.pdf. Accessed 30 Sept, 2011

Raymon LP, Isenschmid DS (2009) Letter to the editor: the possible role of levamisole in illicit cocaine preparations. J Anal Toxicol 33(9):620–622PubMed

Ho ENM, Leung DKK, Leung GNW et al (2009) Aminorex and rexamino as metabolites of levamisole in the horse. Anal Chim Acta 638(1):58–68PubMedCrossRef

Bertol E, Mari F, Milia MGD et al (2011) Determination of aminorex in human urine samples by GC-MS after use of levamisole. J Pharm Biomed Anal 55(5):1186–1189PubMedCrossRef

10.

Macfarlane DG, Bacon PA (1978) Levamisole-induced vasculitis due to circulating immune complexes. Br Med J 1(6110):407–408PubMedCrossRef

11.

Scheinberg MA, Bezerra JB, Almeida FA, Silveira LA (1978) Cutaneous necrotising vasculitis induced by levamisole. Br Med J 1(6110):408PubMedCrossRef

12.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG (1996) Vasculitis associated with levamisole and circulating autoantibodies. Arch Dis Child 75(4):355–356PubMedCrossRef

13.

Rongioletti F, Ghio L, Ginevri F et al (1999) Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children. Br J Dermatol 140(5):948–951PubMedCrossRef

14.

Menni S, Pistritto G, Gianotti R, Ghio L, Edefonti A (1997) Ear lobe bilateral necrosis by levamisole induced occlusive vasculitis in a pediatric patient. Pediatr Dermatol 14(6):477–479PubMedCrossRef

15.

Buchanan JA, Vogel JA, Eberhardt AM (2011) Levamisole-induced occlusive necrotizing vasculitis of the ears after use of cocaine contaminated with levamisole. J Med Toxicol 7(1):83–84PubMedCrossRef

16.

Lee BL, Stone JH, Gimbel D, Khosroshahi A (2010) A 44-year-old woman with cutaneous bullae and extensive skin necrosis. Arthritis Care Res 62(12):1805–1811CrossRef

17.

Walsh NMG, Green PJ, Burlingame RW, Pasternak S, Hanly JG (2010) Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole. J Cutan Pathol 37(12):1212–1219PubMedCrossRef

18.

Dy I, Pokuri V, Olichney J, Wiernik P. Levamisole-adulterated in cocaine causing agranulocytosis, vasculopathy, and acquired protein S deficiency. Annals of Hematology. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21773730. Accessed 30 Sept, 2011

19.

Bhinder SK, Majithia V (2007) Cocaine use and its rheumatic manifestations: a case report and discussion. Clin Rheumatol 26(7):1192–1194PubMedCrossRef

20.

Farhat EK, Muirhead TT, Chaffins ML, Douglass MC (2010) Levamisole-induced cutaneous necrosis mimicking coagulopathy. Arch Dermatol 146(11):1320–1321PubMedCrossRef

21.

Waller JM, Feramisco JD, Alberta-Wszolek L, McCalmont TH, Fox LP (2010) Cocaine-associated retiform purpura and neutropenia: is levamisole the culprit? J Am Acad Dermatol 63(3):530–535PubMedCrossRef

22.

Jenkins J, Babu K, Hsu-Hung E, Robinson-Bostom L, Kroumpouzos G (2011) ANCA-positive necrotizing vasculitis and thrombotic vasculopathy induced by levamisole-adulterated cocaine: a distinctive clinicopathologic presentation. J Am Acad Dermatol 65(1):e14–e16PubMedCrossRef

23.

Ullrich K, Koval R, Koval E, Bapoje S, Hirsh JM (2011) Five consecutive cases of a cutaneous vasculopathy in users of levamisole-adulterated cocaine. J Clin Rheumatol 17(4):193–196PubMed

24.

Zwang NA, Van Wagner LB, Rose S (2011) A case of levamisole-induced systemic vasculitis and cocaine-induced midline destructive lesion: a case report. J Clin Rheumatol 17(4):197–200PubMed

25.

Han C, Sreenivasan G, Dutz JP (2011) Reversible retiform purpura: a sign of cocaine use. Can Med Assoc J 183(9):E597–E600CrossRef

26.

Gross RL, Brucker J, Bahce-Altuntas A et al (2011) A novel cutaneous vasculitis syndrome induced by levamisole-contaminated cocaine. Clin Rheumatol 30(10):1385–1392PubMedCrossRef

27.

Geller L, Whang TB, Mercer SE, Phelps R (2011) Retiform purpura: a new stigmata of illicit drug use? Dermatol Online J 17(2):7PubMed

28.

Van Wieren A, Kapoor M, Rao P, Gardner R (2010) A new low for an old high: neutropenia induced by levamisole-adulterated cocaine. Med Health R I 93(10):320–321PubMed

29.

Click J (2011) Levamisole-induced retiform purpura. J Drugs Dermatol 10(2):217PubMed

30.

Poon SH, Baliog CR Jr, Sams RN, et al. Syndrome of cocaine-levamisole-induced cutaneous vasculitis and immune-mediated leukopenia. Seminars in Arthritis and Rheumatism. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21868067. Accessed 30 Sept, 2011

31.

Friedman DR, Wolfsthal SD (2005) Cocaine-induced pseudovasculitis. Mayo Clin Proc 80(5):671–673PubMedCrossRef

32.

Bradford M, Rosenberg B, Moreno J, Dumyati G (2010) Bilateral necrosis of earlobes and cheeks: another complication of cocaine contaminated with levamisole. Ann Intern Med 152(11):758–759PubMed

33.

de la Hera I, Sanz V, Cullen D, et al. Necrosis of ears after use of cocaine probably adulterated with levamisole. Dermatology (Basel, Switzerland). 2011. http://www.ncbi.nlm.nih.gov/pubmed/21846960. Accessed 30 Sept, 2011

34.

Powell J, Grech H, Holder J (2002) A boy with cutaneous necrosis occurring during treatment with levamisole. Clin Exp Dermatol 27(1):32–33PubMedCrossRef

35.

Neynaber S, Mistry-Burchardi N, Rust C et al (2008) PR3-ANCA-positive necrotizing multi-organ vasculitis following cocaine abuse. Acta Derm Venereol 88(6):594–596PubMed

36.

Zamora-Quezada JC, Dinerman H, Stadecker MJ, Kelly JJ (1988) Muscle and skin infarction after freebasing cocaine (crack). Ann Intern Med 108(4):564–566PubMed

37.

Wiens MO, Son WK, Ross C, Hayden M, Carleton B (2010) Cases: cocaine adulterant linked to neutropenia. Can Med Assoc J 182(1):57–59CrossRef

38.

John S, Manda S, Hamrock D. Cocaine-induced thrombotic vasculopathy. Am J Med Sci. 2011. http://www.ncbi.nlm.nih.gov/pubmed/21817879. Accessed 30 Sept, 2011

39.

Chung C, Tumeh PC, Birnbaum R (2011) Characteristic purpura of the ears, vasculitis, and neutropenia-a potential public health epidemic associated with levamisole-adulterated cocaine. J. Am Acad Dermatol 65(4):722–725.e2PubMedCrossRef

40.

Barbano G, Ginevri F, Ghiggeri GM, Gusmano R (1999) Disseminated autoimmune disease during levamisole treatment of nephrotic syndrome. Pediatr Nephrol 13(7):602–603PubMedCrossRef

41.

Fthenakis A, Klein PA (2011) Retiform purpura in a patient with a history of cocaine use. Dermatol Online J 17(4):12PubMed

42.

Hodinka L, Géher P, Merétey K et al (1981) Levamisole-induced neutropenia and agranulocytosis: association with HLA B27 leukocyte agglutinating and lymphocytotoxic antibodies. Int Arch Allergy Appl Immunol 65(4):460–464PubMedCrossRef

43.

Czuchlewski DR, Brackney M, Ewers C et al (2010) Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 133(3):466–472PubMedCrossRef

44.

Oh SH, Kim DS, Ryu DJ, Lee KH (2009) Extensive cutaneous necrosis associated with low titres of cold agglutinins. Clin Exp Dermatol 34(7):e229–e230PubMedCrossRef

45.

Gulati G, Donato A (2009) Cold hemagglutinin hemolysis and hypercoagulable state due to mycoplasma pneumoniae. ASH Annual Meeting Abstracts 114:5094

46.

Nazarian RM, Van Cott EM, Zembowicz A, Duncan LM (2009) Warfarin-induced skin necrosis. J Am Acad Dermatol 61(2):325–332PubMedCrossRef

47.

Zwang NA, Van Wagner LB, Rose S (2011) A case of levamisole-induced systemic vasculitis and cocaine induced midline destructive lesion: a case report. J Clin Rheumatol 17(4):197–200PubMed

48.

Kouassi E, Caillé G, Léry L, Larivière L, Vézina M (1986) Novel assay and pharmacokinetics of levamisole and p-hydroxylevamisole in human plasma and urine. Biopharm Drug Dispos 7(1):71–89PubMedCrossRef

Title: Lupus anticoagulant and ANCA associated thrombotic vasculopathy due to cocaine contaminated with levamisole: a case report and review of the literature
Authors: Shuchi Gulati
Anthony A. Donato
Publication date: 01-07-2012
Publisher: Springer US
Published in: Journal of Thrombosis and Thrombolysis / Issue 1/2012
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-012-0711-0

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lupus anticoagulant and ANCA associated thrombotic vasculopathy due to cocaine contaminated with levamisole: a case report and review of the literature

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2012

Activated partial thromboplastin time measurement is not associated with clinical outcomes in patients with high-risk non-ST-segment elevation acute coronary syndromes treated with unfractionated heparin

Pre PCI hospital antithrombotic therapy for ST elevation myocardial infarction: striving for consensus

Highlights from the IV International Symposium of Thrombosis and Anticoagulation (ISTA), October 20–21, 2011, Salvador, Bahia, Brazil

Apparent heparin resistance in a patient with infective endocarditis secondary to elevated factor VIII levels

Atopaxar and its effects on markers of platelet activation and inflammation: results from the LANCELOT CAD program

Impact of CYP2C9*3, VKORC1-1639, CYP4F2rs2108622 genetic polymorphism and clinical factors on warfarin maintenance dose in Han-Chinese patients

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page