Cuevas RKP, Gallardo AG, García GC, Carbajal SDA

Language: Spanish
References: 10
Page: 20-27
PDF size: 237.52 Kb.

ABSTRACT

Levamisole is a veterinary anthelmintic drug that, due to its immunomodulatory properties, was once used in the treatment of various cancers and rheumatoid arthritis. However, in the year 2000, the United States Food and Drug Administration (FDA) withdrew its recommendation for use because of severe adverse effects, including agranulocytosis and vasculitis.
This case involves a 22-year-old male with a history of heavy cocaine use who began experiencing subungual lesions on both hands one year prior to hospital admission. He presented with necrosis in both upper limbs, loss of mobility, and purulent exudate, raising suspicion of levamisoleassociated necrosis.
As of 2016, the prevalence of this condition in Mexico remains unknown due to the limited number of reported cases— only two prior reports of levamisole-induced vasculitis exist in the country. This underscores the importance of early recognition and diagnosis of this clinical entity in order to initiate timely intervention and improve patient outcomes.

REFERENCES

1. Márquez J, Aguirre L, Muñoz C, Echeverri A, Restrepo M,Pinto LF. Cocaine-Levamisole-Induced Vasculitis/VasculopathySyndrome. Curr Rheumatol Rep. 2017;19(36):1-5.

2. Roberts JA, Chévez-Barrios P. Levamisole-Induced Vasculitis:A Characteristic Cutaneous Vasculitis AssociatedWith Levamisole-Adulterated Cocaine Arch Pathol LabMed. 2015;139(8):1058-1061.

3. Villatoro-Velázquez JA, Reséndiz-Escobar E, Mujica-SalazarA, Bretón-Cirett M, Cañas-Martínez V, Soto-HernándezI, et al. Encuesta Nacional de Consumo de Drogas, Alcoholy Tabaco 2016-2017 (Internet). México: Secretaría desalud. 2017; (citado 17/01/2025). Disponible en: https://inprf.gob.mx/psicosociales/archivos/ena/ENCODAT_DROGAS_2016-2017.pdf

4. Martínez-Velasco MA, Flores-Suárez LF, Toussaint-Caire S,Rodríguez-Carreón A, Díaz-Lozano M, Sánchez-ArmendárizK. Vasculopatía trombótica por cocaína probablementeadulterada con levamisol: reporte de 2 casos Revista Médicadel Instituto Mexicano del Seguro Social. 2015;53(1):1-3

5. Cascio, Michael J, Kuang-Yu J, Cocaine/levamisole-associatedautoimmune syndrome: a disease of neutrophil-mediatedautoimmunity. Curr Opin Hematol. 2018;25(1):29-36.

6. Calligaris M, Nipoti1 J, Gorosito M, Garrido MG , FernándezBussy, RA. Vasculitis inducida por cocaína. DermatologíaArgentina. 2017;23(4):196-198.

7. Carmona-Rivera C, Purmalek MM, Moore E, WaldmanM, Walter PJ, Garraffo HM, et al. A role for muscarinicreceptors in neutrophil extracellular trap formation and levamisole-induced autoimmunity. CI Insight. 2017;2(3):1-16.

8. Saldarriaga-Santamaria S, Mesa-Mesa C, Mejía-GiraldoAM, Peña-Zúñiga EB Manifestaciones dermatológicassecundarias al uso de cocaína y levamisol. Piel (Barc).2022;37(3):162-168.

9. Gross RL, Brucker J, Bahce-Altuntas A, Abadi MA, LipoffJ, Kotlyar D, et al. A novel cutaneous vasculitis syndromeinduced by levamisole-contaminated cocaine. Clin Rheumatol.2011;30:1385-1392.

10. Salas-Espíndola Y, Peniche-Castellanos A, López-Gehrke I,Mercadillo-Pérez P. Leukocytoclastic Vasculitis Related toCocaine Use. Actas Dermosifiliogr. 2011;102(10):825-836.