Bilateral Necrosis of Earlobes and Cheeks: Another Complication of Cocaine Contaminated With Levamisole
Authors: Mark Bradford
Journal: Annals of Internal Medicine (2010)

Letters1 June 2010Bilateral Necrosis of Earlobes and Cheeks: Another Complication of Cocaine Contaminated With LevamisoleMark Bradford, MD, Brian Rosenberg, MD, Jorge Moreno, MS, and Ghinwa Dumyati, MDMark Bradford, MDFrom University of Rochester Medical Center, Rochester, NY 14607, and Monroe County Department of Public Health, Rochester, NY 14692., Brian Rosenberg, MDFrom University of Rochester Medical Center, Rochester, NY 14607, and Monroe County Department of Public Health, Rochester, NY 14692., Jorge Moreno, MSFrom University of Rochester Medical Center, Rochester, NY 14607, and Monroe County Department of Public Health, Rochester, NY 14692., and Ghinwa Dumyati, MDFrom University of Rochester Medical Center, Rochester, NY 14607, and Monroe County Department of Public Health, Rochester, NY 14692.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-11-201006010-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Levamisole is a veterinary antihelmintic agent that has also been used as an immunomodulating agent to treat cancer, autoimmune diseases, and the nephrotic syndrome. It has been shown to cause neutropenia and vasculitis (1–3). The practice of cutting cocaine with levamisole has been increasing since 2005, and in 2009, 70% of cocaine seized at U.S. borders contained levamisole (4). Recent reports (4, 5) have implicated levamisole as a cause of neutropenia in cocaine abusers. Two cocaine abusers with similar cases of neutropenia and vasculitis presented to the University of Rochester Medical Center, New York, within 8 days of each ...References1. Drew SI, Carter BM, Nathanson DS, Terasaki PI. Levamisole-associated neutropenia and autoimmune granulocytotoxins. Ann Rheum Dis. 1980;39:59-63. [PMID: 7377861] CrossrefMedlineGoogle Scholar2. Scheinberg MA, Bezerra JB, Almeida FA, Silveira LA. Cutaneous necrotising vasculitis induced by levamisole. Br Med J. 1978;1:408. [PMID: 624030] CrossrefMedlineGoogle Scholar3. Rongioletti F, Ghio L, Ginevri F, Bleidl D, Rinaldi S, Edefonti A, et al. Purpura of the ears: a distinctive vasculopathy with circulating autoantibodies complicating long-term treatment with levamisole in children. Br J Dermatol. 1999;140:948-51. [PMID: 10354040] CrossrefMedlineGoogle Scholar4. Centers for Disease Control and Prevention (CDC). Agranulocytosis associated with cocaine use - four States, March 2008-November 2009. MMWR Morb Mortal Wkly Rep. 2009;58:1381-5. [PMID: 20019655] MedlineGoogle Scholar5. Knowles L, Buxton JA, Skuridina N, Achebe I, Legatt D, Fan S, et al. Levamisole tainted cocaine causing severe neutropenia in Alberta and British Columbia. Harm Reduct J. 2009;6:30. [PMID: 19919709] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mark Bradford, MD; Brian Rosenberg, MD; Jorge Moreno, MS; Ghinwa Dumyati, MDAffiliations: From University of Rochester Medical Center, Rochester, NY 14607, and Monroe County Department of Public Health, Rochester, NY 14692.Disclosures: None disclosed. 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