Faculty Collaboration Database

Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010 Mar;133(3):466-72

Date

02/16/2010

Pubmed ID

20154286

DOI

10.1309/AJCPOPQNBP5THKP1

Scopus ID

2-s2.0-77949385200 (requires institutional sign-in at Scopus site)   92 Citations

Abstract

Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency. We identified 20 cases of unexplained agranulocytosis in our practice locations of Albuquerque, NM, and Vancouver, Canada. Epidemiologic investigation revealed recent or ongoing cocaine use in 14 cases (70%). Certain morphologic features, including circulating plasmacytoid lymphocytes, increased bone marrow plasma cells, and mild megakaryocytic hyperplasia, were associated with the cocaine-exposed group. Of 5 patients tested, 3 (60%) were HLA-B27+ and showed antineutrophil antibodies, consistent with known associations of levamisole-induced agranulocytosis. One patient, who was positive for cocaine and levamisole by toxicology testing, died of infectious complications. Inadvertent consumption of levamisole via cocaine is a severely under-appreciated risk factor for agranulocytosis, and specific laboratory features are suggestive of this etiology.

Author List

Czuchlewski DR, Brackney M, Ewers C, Manna J, Fekrazad MH, Martinez A, Nolte KB, Hjelle B, Rabinowitz I, Curtis BR, McFarland JG, Baumbach J, Foucar K

Author

Brian Curtis PhD Director in the Platelet & Neutrophil Immunology Laboratory department at BloodCenter of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Agranulocytosis
Autoantibodies
Cocaine
Drug Contamination
Female
Humans
Hyperplasia
Levamisole
Male
Mass Spectrometry
Middle Aged
Neutrophils
Plasma Cells