Document Detail

Acute coronary syndrome after levamisole-adultered cocaine abuse.
MedLine Citation:
PMID:  24365689     Owner:  NLM     Status:  In-Data-Review    
Cocaine is a well known trigger of acute coronary syndromes. Over the last 10 years levamisole, a veterinary anthelminthic drug has been increasingly used as an adulterant of cocaine. Levamisole was used to treat pediatric nephritic syndrome and rheumatoid arthritis before being withdrawn from the market due to its significant toxicity, i.e. hematological complications and vasculitis. The major complications of levamisole-adultered cocaine reported up to now are hematological and dermatological. The case reported here is of a 25 year old man with a history of cocaine abuse who died at home after complaining of retrosternal pain. Postmortem CT-angiography, autopsy, and chemical and toxicological analyses were performed. An eroded coronary artery plaque was found at the proximal segment of the left anterior descending coronary artery. Two myocardial infarct scars were present in the left ventricle. Microscopic examination of the coronary artery revealed infiltration of eosinophils into the adventitia and intima. Toxicological examination confirmed the presence of cocaine and its metabolites in the peripheral blood, and of levamisole in the urine and pericardial fluid. Eosinophilic inflammatory coronary artery pathologies have been clinically linked to coronary dissection, hypersensitivity coronary syndrome and vasospastic allergic angina. The coronary pathology in the presented case could be a complication of levamisole-adultered cocaine use, in which an allergic or immune-mediated mechanism might play a role. The rise in cocaine addiction worldwide and the increase of levamisole adulterated cocaine highlights the importance of updating our knowledge of the effects of adultered cocaine abuse.
Katarzyna Michaud; Silke Grabherr; Kebede Shiferaw; Franceso Doenz; Marc Augsburger; Patrice Mangin
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Publication Detail:
Type:  Journal Article     Date:  2013-11-05
Journal Detail:
Title:  Journal of forensic and legal medicine     Volume:  21     ISSN:  1878-7487     ISO Abbreviation:  J Forensic Leg Med     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2013-12-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101300022     Medline TA:  J Forensic Leg Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  48-52     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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