Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity

@article{Cascio2018CocainelevamisoleassociatedAS,
  title={Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity},
  author={M. Cascio and K. Jen},
  journal={Current Opinion in Hematology},
  year={2018},
  volume={25},
  pages={29–36}
}
Purpose of review Levamisole was previously used for its immunomodulatory properties to treat rheumatoid arthritis and some cancers. However, because of serious side-effects, it was taken off the market in the United States. Recently, levamisole has reemerged as a popular cocaine adulterant. Some individuals who consume levamisole-adulterated cocaine can develop a life-threatening autoimmune syndrome. In this review, the medical consequences of levamisole exposure and postulated mechanisms by… Expand
Levamisole - A Toxic Adulterant in Illicit Drug Preparations: A Review.
TLDR
Both the medical and forensic communities need to be aware of levamisole and its potential impact on toxicological investigations, because of its varying presence in illicit drug markets. Expand
Multiple cutaneous and mucosal lesions in a patient with cocaine-levamisole–induced vasculopathy syndrome
TLDR
This is a case of a 51-year-old woman with chronic cocaine use who initially presented with multiple cutaneous ulcerations and was later found to have pulmonary and renal involvement and was readmitted with worsening pulmonary and kidneys manifestations requiring initiation of immunosuppressive therapy. Expand
Demographic, Clinical, and Immunologic Correlates among a Cohort of 50 Cocaine Users Demonstrating Antineutrophil Cytoplasmic Antibodies
Objective. Cocaine/levamisole-associated autoimmunity syndrome (CLAAS) is a poorly understood form of drug-induced autoimmunity. Our goals were to better characterize the spectrum of clinical andExpand
Recurrent Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Induced by Levamisole-Adulterated Cocaine.
TLDR
A case of recurrent levamisole-induced vasculitis initially mis diagnosed as systemic lupus erythematosus is presented to highlight this easily misdiagnosed entity and to demonstrate re-exposure leading to recurrent vasculopathy with more extensive clinical manifestations. Expand
Levamisole in Children with Idiopathic Nephrotic Syndrome: Clinical Efficacy and Pathophysiological Aspects
TLDR
It is shown that levamisole is effective in reducing the relapse risk in steroid sensitive forms of nephrotic syndrome with a low frequency of side effects and is considered the least toxic and least expensive therapy. Expand
Systemic sclerosis induced by the use of cocaine: is there an association?
TLDR
Two young adults, after using inhaled cocaine for a few years, were diagnosed with SSc, and the clinical picture of these patients shows a predominance of vascular involvement, including multiple ulcers and SRC. Expand
Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis.
TLDR
Patients with drug-induced AAV usually have a good prognosis if they stop using the offending drug immediately, and recent advances in research on AAV are expected to help better understand the pathogenesis of drug- induced AAV. Expand
Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis
TLDR
Patients with drug-induced AAV usually have a good prognosis if they stop using the offending drug immediately, and recent advances in research on AAV are expected to help better understand the pathogenesis of drug- induced AAV. Expand
[Multifocal inflammatory levamisole-induced leukoencephalopathy].
TLDR
The article discusses the clinical and radiological features of MILL which have a number of similarities of multiple sclerosis (MS) appearance. Expand
Levamisole for children with nephrotic syndrome: new evidence for the use of an "old" drug.
TLDR
The present commentary addresses strengths and limitations of this important  Study of levamisole and mycophenolate mofetil. Expand
...
1
2
...

References

SHOWING 1-10 OF 85 REFERENCES
Adverse effects of levamisole in cocaine users: a review and risk assessment
TLDR
A risk assessment is provided based on the current level of levamisole adulteration in street cocaine, the dose range calculated per gram and the pattern of chronic exposure in heavy or dependent users. Expand
Prednisone and vardenafil hydrochloride for refractory levamisole-induced vasculitis.
TLDR
Clinicians should consider the possibility of levamisole exposure in cocaine users presenting with any combination of fever, neutropenia, and necrotic skin lesions, especially in acral areas including the ears. Expand
Immune-Mediated Agranulocytosis Caused by the Cocaine Adulterant Levamisole: A Case for Reactive Metabolite(s) Involvement
TLDR
An historical account of the levamisole/cocaine story as it first surfaced in 2008 is provided, and it is proposed that the 2,3,5,6-tetrahydroimidazo[2,1-b]thiazole scaffold found in levam isole be categorized as a new structural alert, which is to be avoided in drug design. Expand
Pathologic manifestations of levamisole-adulterated cocaine exposure
TLDR
Patients show skin lesions and renal dysfunction in the setting of extremely high perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), and antibodies to myeloperoxidase, the typical target of p-AN CA, are relatively low if at all present. Expand
Neutrophil extracellular traps as a potential source of autoantigen in cocaine‐associated autoimmunity
TLDR
Enhancement of drug‐induced NET release by CLAA‐IgG provides a potential mechanism linking vasculitis/pupuric skin disease to acute drug exposure in patients with CLAA, and further study of this under‐recognized form of autoimmunity will be likely to provide mechanistic insight into ANCA‐associated Vasculitis and other diseases associated with NETosis. Expand
Cocaine‐related retiform purpura: evidence to incriminate the adulterant, levamisole
The term ‘cocaine‐induced pseudovasculitis' was coined to encompass a constellation of clinical and laboratory findings which mimics a systemic vasculitis but lacks confirmatory evidence ofExpand
Contaminated cocaine and antineutrophil cytoplasmic antibody-associated disease.
TLDR
The development of a systemic autoimmune disease associated with antineutrophil cytoplasmic antibodies (ANCA) in cocaine users appears to be linked to combined cocaine and levamisole exposure, a potentially life-threatening complication of cocaine use. Expand
Pauci-Immune Glomerulonephritis in Individuals With Disease Associated With Levamisole-Adulterated Cocaine
TLDR
Emerging concern of more wide spread organ toxicity associated with the use of levamisole-adulterated cocaine is supported. Expand
A role for muscarinic receptors in neutrophil extracellular trap formation and levamisole-induced autoimmunity.
TLDR
Stimulation of muscarinic receptors on neutrophils by cholinergic agonists may contribute to the pathophysiology observed in drug-induced autoimmunity through the induction of inflammatory responses and neutrophil-induced vascular damage. Expand
Cocaine/levamisole-induced systemic vasculitis with retiform purpura and pauci-immune glomerulonephritis
  • F. Veronese, R. S. O. Dode, +6 authors E. Barros
  • Medicine
  • Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
  • 2016
TLDR
In levamisole-induced systemic vasculitis, the early institution of cocaine abstinence, concomitant with the use of immunosuppressive drugs in severe cases, may prevent permanent end organ damage and associate with better clinical outcomes. Expand
...
1
2
3
4
5
...