1
|
Gillette WM, Singh S. Recurrent noninfectious preseptal cellulitis secondary to cocaine use and levamisole-associated vasculitis. Proc AMIA Symp 2022; 35:534-536. [DOI: 10.1080/08998280.2022.2057157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Wesley M. Gillette
- Department of Ophthalmology, Baylor Scott & White Health System, Temple, Texas
| | - Sonali Singh
- Department of Ophthalmology, Central Texas Veterans Health Care System, Temple, Texas
| |
Collapse
|
2
|
|
3
|
Phillips R, King M, McGilligan JA, Hajela V, Allan K. A retrospective review of four patients with severe nasal destruction secondary to cocaine adulterated with levamisole. Clin Otolaryngol 2021; 46:673-678. [PMID: 33386680 DOI: 10.1111/coa.13710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/24/2020] [Accepted: 12/20/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Rupert Phillips
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Matthew King
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Vijay Hajela
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kimberley Allan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
4
|
McBride JD, Elgart GW. Pyoderma gangrenosum-like facial ulcers in a woman associated with cocaine use and cANCA/anti-PR3 +, pANCA/anti-MPO - serology. JAAD Case Rep 2020; 6:945-950. [PMID: 32913885 PMCID: PMC7472800 DOI: 10.1016/j.jdcr.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Jeffrey D McBride
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida.,Jackson Memorial Hospital, Miami, Florida
| | - George W Elgart
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida.,Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
5
|
Sundararaj KCS, Chapman AB, Sprenger CJ, Collins D, Saha M. Levamisole-induced cutaneous vasculitis. Clin Exp Dermatol 2020; 45:935-937. [PMID: 32597532 DOI: 10.1111/ced.14313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- K C S Sundararaj
- Departments of, Department of, Dermatology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - A B Chapman
- Departments of, Department of, Dermatology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - C J Sprenger
- Departments of, Department of, Dermatology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - D Collins
- Department of, Histopathology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - M Saha
- Departments of, Department of, Dermatology, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| |
Collapse
|
6
|
Hussaini AS, Black CK, Malekzadeh S, Milmoe GJ. Extensive Sinonasal and Oropharyngeal Necrosis as a Consequence of Adulterated Cocaine with Mimicry of ANCA-Positive Vasculitis. OTO Open 2020; 3:2473974X19894239. [PMID: 32285022 PMCID: PMC7119445 DOI: 10.1177/2473974x19894239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adnan S Hussaini
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Cara K Black
- Department of Plastic and Reconstructive Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.,Department of Otolaryngology-Head & Neck Surgery, Washington DC Veterans Affairs Medical Center Washington, District of Columbia, USA
| | - Gregory J Milmoe
- Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
7
|
Abstract
Levamisole is a veterinary antihelminthic, chemotherapeutic agent, and immunomodulator that also is used as an adulterant and cutting agent in cocaine distribution. This drug may potentiate the sympathomimetic actions of cocaine and can cause neutropenia, agranulocytosis, purpuric retiform lesions, and skin necrosis. This article describes two cases of suspected levamisole-induced vasculitis. No standardized diagnostic or treatment algorithm exists for this challenging condition. Diagnosis and treatment require a multidisciplinary team approach.
Collapse
|
8
|
Abstract
Aminorex (5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) and 4-methylaminorex (4-methyl-5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) are psychostimulants that have long been listed in Schedules IV and I of the UN Convention on Psychotropic Substances of 1971. However, a range of psychoactive analogues exist that are not internationally controlled and therefore often classified as new psychoactive substances (NPS). Aminorex analogues encompass failed pharmaceuticals that reemerged as drugs of abuse, and newly synthesized substances that were solely designed for recreational use by clandestine chemists. NPS, sometimes also referred to as "designer drugs" in alignment with a phenomenon arising in the early 1980s, serve as alternatives to controlled drugs. Aminorex and its derivatives interact with monoaminergic neurotransmission by interfering with the function of monoamine transporters. Hence, these compounds share pharmacological and neurochemical similarities with amphetamines and cocaine. The consumption of aminorex, 4-methylaminorex and 4,4'-dimethylaminorex (4-methyl-5-(4-methylphenyl)-4,5-dihydro-1,3-oxazol-2-amine) has been associated with adverse events including death, bestowing an inglorious fame on aminorex-derived drugs. In this Review, a historical background is presented, as well as an account of the pharmacodynamic and pharmacokinetic properties of aminorex and various analogues. Light is shed on their misuse as drug adulterants of well-established drugs on the market. This Review not only provides a detailed overview of an abused substance-class, but also emphasizes the darkest aspect of the NPS market, i.e., deleterious side effects that arise from the ingestion of certain NPS, as knowledge of the pharmacology, the potency, or the identity of the active ingredients remains obscure to NPS users.
Collapse
Affiliation(s)
- Julian Maier
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Felix P. Mayer
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Simon D. Brandt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Harald H. Sitte
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| |
Collapse
|
9
|
Steinmetz A, Steffens L, Morás AM, Prezzi F, Braganhol E, Saffi J, Ortiz RS, Barros HMT, Moura DJ. In vitro model to study cocaine and its contaminants. Chem Biol Interact 2018; 285:1-7. [PMID: 29475069 DOI: 10.1016/j.cbi.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 12/18/2022]
Abstract
Cocaine is one of the most popular illicit drug worldwide. Due its great addictive potential, which leads to euphoria and hyperactivity, it is considered a public health concern. At the central nervous system, the drug acts inhibiting catecholamine re-uptake. It is now known that in addition to the toxicity of the drug itself, the contaminants present in the street drug have raised concern about the harmful effects on health. Toxicological in vivo and in vitro studies have demonstrated the toxic effects of cocaine correlated with the generation of reactive oxygen species (ROS), which in turn lead to oxidative damage to the cells. Therefore the aim of this work was to propose an in vitro model that reunites the main parameters of toxicity of the cocaine already observed in the literature so far, and we tested this model using cocaine and seizure cocaine sample (SCS), kindly provided by Federal Police of Brazil. For that, we used a C6 glioblastoma cells and evaluated cell death, oxygen reactive species induction, oxidation of macromolecules as membrane lipids and DNA and loss of mitochondrial membrane potential after cocaine exposure. The results showed that cocaine can decrease cellular viability in a dose-dependent way in the C6 cell immortalized and astrocytes primary culture. Cocaine also induced cellular death by apoptosis. However, in the seizure cocaine sample (SCS), the predominant cell death was due to necrosis. Using dichlorofluorescein (DCF) assay, we confirmed ROS production after cocaine exposition. In agreement with these findings, occurred an increasing in MDA production, as well as increased superoxide dismutase (SOD) and catalase (CAT) activity. The induction of DNA damage was observed after cocaine. Our results demonstrate the occurrence of mitochondrial dysfunction by depolarization of mitochondrial membrane as a consequence of cocaine treatment. In summary, these results demonstrated that cocaine can induce reactive oxygen species formation, leading to oxidative stress. As a consequence of this unbalance, DNA damage, lipidic peroxidation and loss of mitochondrial membrane occurred, which could be an answer to cell death observed.
Collapse
Affiliation(s)
- Aline Steinmetz
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Luiza Steffens
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Ana Moira Morás
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Flávia Prezzi
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Elizandra Braganhol
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Jenifer Saffi
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Rafael Scorsatto Ortiz
- Divisão Técnica-Científica, Policia Federal do Brasil, Porto Alegre, RS, 90160-092, Brazil.
| | - Helena M T Barros
- Laboratório de Neurofarmacologia, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| | - Dinara Jaqueline Moura
- Laboratório de Genética Toxicológica, Universidade Federal de Ciências da Saúde de, Porto Alegre, RS, 90050-170, Brazil.
| |
Collapse
|
10
|
Sayadi L, Laub D. Levamisole-Induced Vasculitis. EPLASTY 2018; 18:ic5. [PMID: 29520317 PMCID: PMC5821816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lohrasb Sayadi
- University of California, Irvine, Irvine California and University of Vermont, Burlington Vermont
| | - Donald Laub
- University of California, Irvine, Irvine California and University of Vermont, Burlington Vermont
| |
Collapse
|
11
|
Surgical Management of Levamisole-Adulterated Cocaine Induced Soft Tissue Necrosis: Case Study and Treatment Algorithm. J Burn Care Res 2018; 38:e638-e646. [PMID: 27606557 DOI: 10.1097/bcr.0000000000000428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Levamisole is an increasingly common cocaine adulterant that can cause severe and rapid onset cutaneous vasculitis in humans. While most cases may be managed conservatively, we describe a series of patients in whom the extent of skin and soft tissue necrosis mandated surgical intervention. A retrospective review of all patients admitted to one of two regional burn centers between 2006 and 2016 for soft tissue necrosis after exposure to levamisole-adulterated cocaine was included in our study. Ten patients, majority female (9/10) with an average age of 43.4 years (range 31-57), were included. Cocaine usage before presentation averaged 6 days (range 1-14). Presenting complaints consisted of arthralgia (5/10), fever (7/10), and purpuric lesions (10/10). Average TBSA involvement was 23.5% (range 4-70). Immunological testing revealed perinuclear antineutrophil cytoplasmic antibody (pANCA+) in 8 of 10 and cytoplasmic antineutrophil cytoplasmic antibody (cANCA+) in 4 of 8 patients. Operative intervention occurred by postadmission day 11.6 (range 3-30). The mean number of operations required was 3 (range 2-6); length of stay averaged 46.8 days (range 14-120); and survival to discharge was 100% (10/10). To our knowledge, this is the largest case study detailing the surgical management of levamisole-associated skin necrosis. Additionally, we describe the most extensive case of this disease process at 70% TBSA involvement. Based on our experience, we recommend waiting for purpuric rash resolution and soft tissue necrosis to be fully demarcated before fascial debridement and then staged skin grafting with allograft followed by autograft.
Collapse
|
12
|
Unexpected Complication of Cocaine-Associated Anti-Neutrophil Cytoplasmic Antibody Vasculitis Related to Persistent In-Hospital Cocaine Use. J Addict Med 2017; 11:157-160. [DOI: 10.1097/adm.0000000000000290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Swe T, Pervil-Ulysse M, Baqui AA. Cocaine-induced vasculitis with cutaneous manifestation: A recurrent episode after 2 years. J Family Med Prim Care 2017; 5:712-715. [PMID: 28217616 PMCID: PMC5290793 DOI: 10.4103/2249-4863.197294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cocaine is a popular recreational drug in the United States, and up to 70% of the seized cocaine contains levamisole which is an antihelminthic that can cause cutaneous vasculitis with necrosis and positive antineutrophil cytoplasmic antibodies (ANCAs). Here, we report a unique case of recurrent cocaine-induced vasculitis in a patient who smokes cocaine for more than 20 years. A 38-year-old woman complained of painful erythematous rash in her right arm and right thigh which appeared some hours after smoking cocaine. Physical examination revealed tender, erythematous base, retiform purpura with necrosis and bullae. Serological test showed high atypical perinuclear ANCA titer of 1:320 and antimyeloperoxidase antibody level of 20.4 U/mL. Cocaine-induced vasculitis should be one of the differential diagnoses in cocaine abusers who present with painful rash and areas of necrosis. Early diagnosis is important since it is an emerging public health concern.
Collapse
Affiliation(s)
- Thein Swe
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, USA
| | - Mona Pervil-Ulysse
- Division of Rheumatology, Interfaith Medical Center, Brooklyn, New York, USA
| | - Aam A Baqui
- Department of Pathology, Interfaith Medical Center, Brooklyn, New York, USA
| |
Collapse
|
14
|
Imbernón-Moya A, Chico R, de la Hera I, Gallego-Valdés MÁ. Leukocytoclastic vasculitis related to cocaine-adulterated levamisole. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:795-797. [PMID: 27365279 DOI: 10.1016/j.ad.2016.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- A Imbernón-Moya
- Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 - Leganés (Madrid), Spain.
| | - R Chico
- Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 - Leganés (Madrid), Spain
| | - I de la Hera
- Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 - Leganés (Madrid), Spain
| | - M Á Gallego-Valdés
- Servicios de Dermatologia, del Hospital Universitario Severo Ochoa, Avda. de Orellana s/n. 28911 - Leganés (Madrid), Spain
| |
Collapse
|
15
|
Imbernón-Moya A, Chico R, de la Hera I, Gallego-Valdés M. Leukocytoclastic vasculitis related to cocaine-adulterated levamisole. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
16
|
Le Garff E, Tournel G, Becquart C, Cottencin O, Dupin N, Delaporte E, Hedouin V. Extensive Necrotic Purpura in Levamisole-Adulterated Cocaine Abuse - A Case Report. J Forensic Sci 2016; 61:1681-1685. [PMID: 27500987 DOI: 10.1111/1556-4029.13176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 11/28/2022]
Abstract
Levamisole, which is used as an adulterated compound of cocaine, is currently being seen year after year in cocaine intoxication. For a few cases in the last decade, necrotic purpura and neutropenia after levamisole/cocaine intoxication have been described in the medical community. Herein, we present an original case of levamisole intoxication of a 40-year-old woman who smoked heroin and cocaine few during a month. She rapidly presented an extensive necrotic purpura of the nose, cheeks and extremities (lower and upper), and immunologic reactions (positive anti-MPO and anti-HNE). Levamisole was detected on hairs with ultra-high performance liquid chromatography and tandem mass spectrometry. The case reports also a probable cocaine supplier deceit, which bring pure drug for hospital investigation after the intoxication of his client. The intoxicated woman had survived with several skin and chronic pain complications. That case recalls the knowledge about levamisole with a short review of the forensic literature.
Collapse
Affiliation(s)
- Erwan Le Garff
- Service de Médecine Légale, CHU Lille, University Lille, UTML 7367, F-59000, Lille, France
| | - Gilles Tournel
- Service de Médecine Légale, CHU Lille, University Lille, UTML 7367, F-59000, Lille, France.,Service de toxicologie, CHU Lille, University Lille, F-59000, Lille, France
| | - Coralie Becquart
- Service de dermatologie, CHU Lille, University Lille, F-59000, Lille, France
| | - Olivier Cottencin
- ScaLab CNRS UMR 9193, Service d'addictologie, CHU Lille, University Lille, F-59000, Lille, France
| | - Nicolas Dupin
- Service de dermatologie, CHU Cochin, Rue du Faubourg St Jacques, 75014, Paris, France
| | - Emmanuel Delaporte
- Service de dermatologie, CHU Lille, University Lille, F-59000, Lille, France
| | - Valéry Hedouin
- Service de Médecine Légale, CHU Lille, University Lille, UTML 7367, F-59000, Lille, France
| |
Collapse
|
17
|
Imbernón-Moya A, Chico R, Aguilar-Martínez A. [Cutaneous and mucosal manifestations associated with cocaine use]. Med Clin (Barc) 2016; 146:544-9. [PMID: 27033438 DOI: 10.1016/j.medcli.2016.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
Complications due to cocaine are a public health problem. The typical cutaneous disease is leukocytoclastic vasculitis and/or thrombotic vasculopathy affecting mainly the ears. No intense systemic involvement is usually present, but there may be several cutaneous, mucosal and systemic manifestations. Other findings associated as arthralgia, neutropaenia or agranulocytosis, low titer positive antinuclear antibodies, antiphospholipid antibody positivity and neutrophil cytoplasmic antibodies against multiple antigens help the diagnosis. This disease requires a clinical suspicion with a clinical history, a complete physical examination and a broad differential diagnosis for an early and correct diagnosis. The course is usually self-limited. In most cases the only treatment is to discontinue the use of cocaine associated with symptomatic treatment, no proven benefit of systemic corticosteroids.
Collapse
Affiliation(s)
- Adrián Imbernón-Moya
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - Ricardo Chico
- Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | |
Collapse
|
18
|
|
19
|
Alvarez JC, Boyer JC, Verstraete AG, Pelissier-Alicot AL. Conduite automobile et cocaïne : bases bibliographiques pour un consensus de la Société française de toxicologie analytique. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2015. [DOI: 10.1016/j.toxac.2015.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|