Reversible thrombocytopenia with levamisole

Winquist, Eric; Lassam, Norman J.

doi:10.1002/mpo.2950240409

Cited by 12 publications

(5 citation statements)

References 13 publications

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“…The predominant adverse effects observed with it are haematological: agranulocytosis, leucopenia1 5 9–12; immunological: cutaneous vasculopathy, vasculitis and pseudovasculitis2 5 7 13 14 and neurological: multifocal inflammatory leucoencephalopathy 5 9 15 16. Other adverse effects that have been described are thrombocytopaenia,10 17–19 aplastic anaemia,4 pulmonary hypertension,4 renal failure,15 20 21 acute coronary syndrome,22 headaches and arthralgias 5. Among these, agranulocytosis is the most common adverse effect noted, followed by vasculopathy 23.…”

Section: Discussionmentioning

confidence: 99%

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A fatal case of levamisole induced bone marrow failure

George¹,

Janeela

Sigamani

et al. 2019

BMJ Case Rep

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A 20-year-old college student presented with high grade, intermittent fever for 10 days associated with blood stained loose stools after taking tablet levamisole for 17 days for vitiligo vulgaris. He was febrile, had a toxic appearance and appeared pale. Investigations showed neutropaenia with thrombocytopaenia. Blood cultures were sterile and stool cultures did not grow any enteric pathogens. His bone marrow examination was suggestive of an aplastic anaemia. He was administered empirical antibiotics, granulocyte colony stimulating factor and platelet transfusions. However, his fever and blood stained stools persisted. A repeat bone marrow examination after 2 weeks still revealed a hypoplastic marrow. Hence, a diagnosis of a levamisole induced bone marrow failure was made. While being worked up for an allogeneic stem cell transplantation, he developed neutropaenic enterocolitis and refractory septic shock with carbapenem resistantKlebsiella pneumoniaeand succumbed to his illness.

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Section: Discussionmentioning

confidence: 99%

“…Agranulocytosis is seen in 2.5%–13% of the patients using Lm as an immunomodulator 1. Lm has also rarely been reported to cause thrombocytopaenia 10 17–19. The precise mechanism by which Lm induces agranulocytosis has not been elucidated.…”

Section: Discussionmentioning

confidence: 99%

A fatal case of levamisole induced bone marrow failure

George¹,

Janeela

Sigamani

et al. 2019

BMJ Case Rep

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“…As a chemotherapeutic and immunomodulatory agent, adverse effects from levamisole ingestion include thrombocytopenia, microvascular thrombosis resulting in formation of palpable purpura, vasculitis, and ulcers of the mouth and skin . The purpura that results seem to have a predilection for involving the ear lobes .…”

Section: Discussionmentioning

confidence: 99%

Palpable Purpura Complicated by Streptococcal Toxic Shock Syndrome Resulting in Limb Necrosis and Amputation: A Case of Levamisole and Cocaine Coingestion

Freyer

Peters

2012

Pharmacotherapy

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Palpable purpura resulting from cocaine and levamisole coingestion has been reported with increasing frequency over the last several years as distribution of this drug combination becomes more universal. Toxicity from ingestion of this dangerous combination is difficult to diagnose due to the multitude of possible clinical presentations, variety of possible adulterants, and elusive nature of levamisole given its short half-life and limited availability of detection methods. Levamisole is a chemotherapeutic and immunomodulatory agent currently marketed as a veterinary anthelmintic. We describe the case of a 48-year-old woman admitted to our intensive care unit with a diagnosis of streptococcal toxic shock syndrome (STSS), confirmed from fluid taken from an elbow lesion that grew Streptococcus pyogenes. She was noted to have bullae of the elbow and diffuse purpura with necrotic centers covering a large portion of her body (trunk, legs, arms, back, toes, fingers, and tip of nose). On further evaluation, she was found to have ingested levamisole-tainted cocaine. The patient's complications related to either cocaine and levamisole coingestion or STSS included thrombocytopenia, acute renal failure, and limb necrosis. Thrombocytopenia gradually improved upon treatment with prednisone, and acute renal failure improved with intravenous fluid resuscitation; however, she subsequently required several appendage amputations due to severe gangrene. Clinicians must have high suspicion for ingestion of this drug combination and request prompt testing of urine samples for levamisole if a patient who admits to illicit drug use presents with purpuric or necrotic skin lesions.

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“…6 Reversible thrombocytopenia and arthritis have also been reported. 1,7 There are currently no standardized diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

Cocaine/levamisole-induced vasculopathy

Chevalier¹,

Natalie²

2012

Scripta Medica

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A 45-year-old woman was admitted to the hospital with non-infl ammatory retiform purpura of the extremities and face that developed shortly after using cocaine. Her laboratory evaluation revealed neutropenia, thrombocytopenia, phospholipid antibodies, antinuclear antibodies, and perinuclear antineutrophil cytoplasmic antibodies. A skin biopsy showed a thrombotic vasculopathy. Based on her constellation of fi ndings, a diagnosis of cocaine/levamisole-induced vasculopathy was rendered. Historically, levamisole has been utilized for its anthelmintic and immunomodulatory properties; it is now widely used as a cocaine adulterant. The classic tetrad of the cocaine/levamisole-induced vasculopathy syndrome includes non-infl ammatory retiform purpura involving the cheeks and/or earlobes, neutropenia, ANCA positivity, and evidence of recent cocaine use. The differential diagnosis, clinical approach, etiology, and management of this entity are discussed.

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Reversible thrombocytopenia with levamisole

Cited by 12 publications

References 13 publications

A fatal case of levamisole induced bone marrow failure

A fatal case of levamisole induced bone marrow failure

Palpable Purpura Complicated by Streptococcal Toxic Shock Syndrome Resulting in Limb Necrosis and Amputation: A Case of Levamisole and Cocaine Coingestion

Cocaine/levamisole-induced vasculopathy

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