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Resident: The Dramatic Impact of Cutting Cocaine with Levamisole
EP30942
Poster Title: Resident: The Dramatic Impact of Cutting Cocaine with Levamisole
Submitted on 07 Nov 2019
Author(s): Kalpesh Mistry MD PGY-3, Robert Quick MD PGY-3,William Cantrell MD PGY-2, Sonya Chelliah MD PGY-2, Susan Brickle MD
Affiliations: Memorial Satilla Health
Poster Views: 459
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Poster Information
Abstract: Cocaine use in the US remains an ongoing burden and is associated with a host of well-studied and commonly understood medical consequences. Users of cocaine purchase a product which has been ‘cut’ or diluted by sellers to increase its volume. Levamisole, an anthelminthic and antineoplastic agent previously banned in the United States, was found to be a common cutting agent and was present in approximately 80% of cocaine tested in the US. Reports recently began to surface indicating a trend in cocaine users presenting with a similar constellation of findings which could not be directly attributed to cocaine and its known effects. Most notably was the consistent appearance of an atypical vasculitis. Investigation into the cause of this condition revealed a direct link between the ingestion of levamisole-adulterated cocaine and the development of vasculitis.

Although this link has been established and its presentation better recognized among physicians, the diagnosis and management of this complication have not been intensively studied or findings widely disseminated. Furthermore, there are currently no widely accepted diagnostic criteria or definitive recommendations on the management of affected patients. The following presentation will review the basic mechanism(s) resulting in this condition and is intended to provide information which may aid in the development of appropriate clinical suspicion and diagnostic approaches, highlight differential diagnoses and associated complications, and review treatments which have been applied in documented cases. The information contained herein is based upon review of multiple cases published within and outside of the US.
Summary: Cocaine use in the United States remains an ongoing burden and is associated with a host of well-studied and commonly understood medical consequences.  Users of cocaine purchase a product which has been ‘cut’ or diluted by sellers to increase its volume.  
References: Arora, N., Jain, T., Bhanot, R. and Natesan, S. (2012). Levamisole-induced leukocytoclastic vasculitis and neutropenia in a patient with cocaine use: An extensive case with necrosis of skin, soft tissue, and cartilage. Addiction Science & Clinical Practice, 7(1).
Carlson,A.(2014)Pauci-Immune Glomerulonephritis in Individuals With Disease Associated With Levamisole-Adulterated Cocaine. Medicine, 93 (17), 290-297. doi: 10.1097/MD.0000000000000090im
Dherange PA,Beatty N, Al-Khashman A.Levamisole-adulterated cocaine: a case of retiform purpura, cutaneous necrosis and neutropenia. BMJ Case Rep Published online: 10.27.2019. doi:10.1136/bcr-2015-211768
HAHN, E. and BOGOCH, I. (2015). Levamisole-induced Vasculitis in a Cocaine User. [online] The Journal of Rheumatology. http://www.jrheum.org/content/42/10/1924 [Accessed 31 Oct. 2019].
Lee, K., Ladizinski, B. and Federman, D. (2012). Complications Associated With Use of Levamisole-Contaminated Cocaine: An Emerging Public Health
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