{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T06:14:26Z","timestamp":1788329666831,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Forensic Sciences"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cases of levamisole overdose without coingestants in human subjects are rare. Existing knowledge of human toxicity depends in part on records of adverse events of therapeutic use such as nausea, vomiting, headache, and rarer central nervous system effects. Much of our knowledge also comes from levamisole's role as an adulterant in cocaine, where it is known to have immune modulatory properties and is associated with vasculitis. The few cases of levamisole\u2010only toxicity are either non\u2010fatal or lack clinical details. We present the first case of a fatal, oral ingestion of levamisole in a patient who presented alive with clinical symptoms and had treatment documented. The patient's early symptoms included nausea, vomiting, tremors, and visual changes. Following this, the patient experienced bradycardia followed by pulseless electrical activity cardiac arrest. This presentation was consistent with what would be expected of the pharmacodynamic effects of levamisole as a nicotinic agonist. Levamisole's presence was confirmed by post\u2010mortem confirmatory testing, with a recorded femoral blood concentration of 19,000\u2009ng\/mL. The clinical picture and post\u2010mortem testing were consistent with the cause of death as levamisole overdose.<\/jats:p>","DOI":"10.1111\/1556-4029.70387","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T03:59:20Z","timestamp":1781927960000},"page":"2469-2473","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unintentional fatal overdose of veterinary levamisole in a human subject"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5331-5119","authenticated-orcid":false,"given":"Rebecca","family":"Kusko","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Division of Medical Toxicology University of Iowa Health Care  Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serah","family":"Oyewole","sequence":"additional","affiliation":[{"name":"Houston Methodist West  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Tarrant County Medical Examiner's Office  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shelly","sequence":"additional","affiliation":[{"name":"Tarrant County Medical Examiner's Office  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Price","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Medical Center\u2013Grapevine  Grapevine TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8306-6782","authenticated-orcid":false,"given":"Kurt","family":"Kleinschmidt","sequence":"additional","affiliation":[{"name":"Division of Medical Toxicology University of Texas Southwestern Medical Center  Dallas TX USA"},{"name":"Perinatal Intervention Program (PIP) Parkland Health and Hospital System  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2016.01.005"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000851"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010150\u20104\u2010200902170\u201000102"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2460\/javma.1980.176.10.1166"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rvsc.2022.09.038"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/00480169.2016.1153438"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12024\u2010020\u201000336\u2010y"},{"issue":"15","key":"e_1_2_9_9_1","article-title":"Intoxication aigu\u00eb au l\u00e9vamisole [Acute levamisole poisoning]","volume":"27","author":"Joly C","year":"1998","journal-title":"Presse Med"},{"key":"e_1_2_9_10_1","first-page":"429","article-title":"Detection of levamisole toxicity by chromatographic technique","volume":"14","author":"Soliman M","year":"1984","journal-title":"J Egypt Soc Parasitol"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxac.2014.12.001"},{"key":"e_1_2_9_12_1","unstructured":"Valley Vet.Prohibit levamisole drench powder.2025.https:\/\/www.valleyvet.com\/ct_detail.html?pgguid=30e0794a\u20107b6a\u201011d5\u2010a192\u201000b0d0204ae5"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002800050770"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAF.0000000000000106"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-198202000-00004"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(13)76150-9"},{"key":"e_1_2_9_17_1","unstructured":"Trazodone drug level.The University of Iowa Department of Pathology Laboratory services handbook.2025.https:\/\/www.healthcare.uiowa.edu\/path_handbook\/handbook\/test774.html"},{"key":"e_1_2_9_18_1","first-page":"1203","volume-title":"Goldfrank's toxicologic emergencies","author":"Fernandez D","year":"2019"},{"key":"e_1_2_9_19_1","unstructured":"UpToDate.Levamisole: International drug information.2025.https:\/\/www.uptodate.com\/contents\/levamisole\u2010international\u2010drug\u2010information\u2010concise"}],"container-title":["Journal of Forensic Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1556-4029.70387","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1556-4029.70387","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1556-4029.70387","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T05:38:15Z","timestamp":1788327495000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1556-4029.70387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/1556-4029.70387"],"URL":"https:\/\/doi.org\/10.1111\/1556-4029.70387","archive":["Portico"],"relation":{},"ISSN":["0022-1198","1556-4029"],"issn-type":[{"value":"0022-1198","type":"print"},{"value":"1556-4029","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"2025-12-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}