Home
|
Inbox
|
Search
|
View Abstract
Febrile Neutropenia in a Cocaine User: A Case of Levamisole Induced Agranulocytosis
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A6913 - Febrile Neutropenia in a Cocaine User: A Case of Levamisole Induced Agranulocytosis
Author Block: M. Khan1, Z. Khan1, F. M. Khateeb2, A. Moustafa1, M. Taleb2, Y. Yoon2; 1Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States, 2Pulmonary/Critical Care, University of Toledo Medical Center, Toledo, OH, United States.
Introduction: Cocaine abuse remains a significant health problem in United States. For cutting the cost and meeting the demand a number of adulterants are used with cocaine. Of this the most popular is levamisole. Levamisole is a synthetic imidazothiazole derivative, which was initially introduced as an anthelmintic agent in 1966. In 1970s, it found widespread use as an immunomodulating agent for treatment of various connective tissue disorders and colorectal carcinoma. However, in year 2000, it was withdrawn due to severe side effects toxicity related to it. Levamisole is known to cause severe neutropenia and agranulocytosis.
Case Report: 59 year old African American male patient presented to the hospital with 3day history of fever and sore throat. He has a known history of cocaine abuse and admitted used cocaine recently. Initial lab work showed severe neutropenia with white count of 0.6 X 103/mm3 (4-11 X 103/mm3) and absolute neutrophil count of 24. Hemoglobin and platelets count were normal. Urine toxicology screen obtained at the time admission was positive for cocaine. Patient was managed as a case of febrile neutropenia. Cultures were drawn and empiric antibiotic (cefepime) was started. Computed Tomography of neck showed tonsillar inflammation without any abscess or fluid collection. Patient was extensively worked up to identify the cause of neutropenia but no significant abnormality could be detected. Consistent with history of cocaine use and negative workup for common causes of neutropenia, levamisole induced neutropenia was suspected. Treatment with granulocyte colony stimulating factor (G-CSF) was initiated. Over the course of next few days patients white count started improving and returned to normal 7th day post admission. Patient reported improvement in symptoms and recovered fully. He was discharged home.
Discussion: Levamisole induced agranulocytosis should be considered in patients who presents with neutropenia and have a history of cocaine use. Exposure to levamisole can be tested in urine by gas chromatography however this test is of limited utility due to short half-life of levamisole (5-6 hours). Clinicians should be aware of this entity to early identify serum and urine levamisole and consider it a potential etiology of neutropenia and agranulocytosis when other causes have been ruled out.
Author Block: M. Khan1, Z. Khan1, F. M. Khateeb2, A. Moustafa1, M. Taleb2, Y. Yoon2; 1Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States, 2Pulmonary/Critical Care, University of Toledo Medical Center, Toledo, OH, United States.
Introduction: Cocaine abuse remains a significant health problem in United States. For cutting the cost and meeting the demand a number of adulterants are used with cocaine. Of this the most popular is levamisole. Levamisole is a synthetic imidazothiazole derivative, which was initially introduced as an anthelmintic agent in 1966. In 1970s, it found widespread use as an immunomodulating agent for treatment of various connective tissue disorders and colorectal carcinoma. However, in year 2000, it was withdrawn due to severe side effects toxicity related to it. Levamisole is known to cause severe neutropenia and agranulocytosis.
Case Report: 59 year old African American male patient presented to the hospital with 3day history of fever and sore throat. He has a known history of cocaine abuse and admitted used cocaine recently. Initial lab work showed severe neutropenia with white count of 0.6 X 103/mm3 (4-11 X 103/mm3) and absolute neutrophil count of 24. Hemoglobin and platelets count were normal. Urine toxicology screen obtained at the time admission was positive for cocaine. Patient was managed as a case of febrile neutropenia. Cultures were drawn and empiric antibiotic (cefepime) was started. Computed Tomography of neck showed tonsillar inflammation without any abscess or fluid collection. Patient was extensively worked up to identify the cause of neutropenia but no significant abnormality could be detected. Consistent with history of cocaine use and negative workup for common causes of neutropenia, levamisole induced neutropenia was suspected. Treatment with granulocyte colony stimulating factor (G-CSF) was initiated. Over the course of next few days patients white count started improving and returned to normal 7th day post admission. Patient reported improvement in symptoms and recovered fully. He was discharged home.
Discussion: Levamisole induced agranulocytosis should be considered in patients who presents with neutropenia and have a history of cocaine use. Exposure to levamisole can be tested in urine by gas chromatography however this test is of limited utility due to short half-life of levamisole (5-6 hours). Clinicians should be aware of this entity to early identify serum and urine levamisole and consider it a potential etiology of neutropenia and agranulocytosis when other causes have been ruled out.
|
Home
|
Inbox
|
Search
|