{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:19:29Z","timestamp":1759961969700},"reference-count":26,"publisher":"AACN Publishing","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,1]]},"abstract":"<jats:p>Cocaine is often \u201ccut\u201d with various additives to increase the profitability of the drug. One of the most common additives on today\u2019s market is levamisole, an anthelmintic medication used to destroy and expel parasitic worms in animals. The use of levamisole-contaminated cocaine can result in agranulocytosis and vasculitis (inflammation and constriction of small blood vessels). The resulting clotting and decrease in peripheral blood flow lead to cutaneous lesions, particularly on the ears, face, hands, and feet, and in severe cases can cause generalized tissue necrosis throughout the entire body. Treatment is generally supportive, and symptoms typically abate with complete cessation of cocaine use. However, symptoms may recur with subsequent cocaine use and, as this case illustrates, severe neutropenia and extensive vasculitis may lead to overwhelming sepsis and death.<\/jats:p>","DOI":"10.4037\/ccn2017977","type":"journal-article","created":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T04:15:15Z","timestamp":1501560915000},"page":"49-57","source":"Crossref","is-referenced-by-count":6,"title":["Levamisole-Adulterated Cocaine Leading to Fatal Vasculitis: A Case Report"],"prefix":"10.4037","volume":"37","author":[{"given":"Belinda B.","family":"Hammond","sequence":"first","affiliation":[{"name":"Belinda B. Hammond is the critical care clinical nurse educator and coordinator of the new graduate Academy for Critical Care Nursing at Cone Health, Greensboro, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Craven","sequence":"additional","affiliation":[{"name":"Jordan Craven is a registered nurse in the cardiac ICU, Novant Health Forsyth Medical Center, Winston Salem, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2471","reference":[{"key":"2019112612142662000_b1-0370049","unstructured":"The truth about cocaine: international statistics. Foundation for a Drug-Free World website. http:\/\/www.drugfreeworld.org\/drugfacts\/cocaine\/international-statistics.html. Accessed April 30, 2017."},{"key":"2019112612142662000_b2-0370049","unstructured":"Cocaine. National Institute on Drug Abuse website. https:\/\/\/www.drugabuse.gov\/drugs-abuse\/cocaine. Updated June 2016. Accessed April 25, 2017."},{"key":"2019112612142662000_b3-0370049","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/MOH.0b013e32834da9ef","article-title":"Agranulocytosis and other consequences due to use of illicit cocaine contaminated with levamisole","volume":"19","author":"Buchanan","year":"2011","journal-title":"Curr Opin Hematol"},{"key":"2019112612142662000_b4-0370049","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1940-0640-7-19","article-title":"Levamisole-induced leukocytoclastic vasculitis and neutropenia in a patient with cocaine use: an extensive case with necrosis of skin, soft tissue, and cartilage","volume":"7","author":"Arora","year":"2012","journal-title":"Addict Sci Clin Pract"},{"issue":"4","key":"2019112612142662000_b5-0370049","doi-asserted-by":"crossref","first-page":"528","DOI":"10.3122\/jabfm.2012.04.110177","article-title":"Agranulocytosis from levamisole-adulterated cocaine","volume":"25","author":"Caldwell","year":"2012","journal-title":"J Am Board Fam Med"},{"key":"2019112612142662000_b6-0370049","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.neuint.2013.11.010","article-title":"Aminorex, a metabolite of the cocaine adulterant levamisole, exerts amphetamine like actions at monoamine transporters","volume":"73","author":"Hofmaier","year":"2014","journal-title":"Neurochem Int"},{"issue":"6","key":"2019112612142662000_b7-0370049","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.mayocp.2012.03.010","article-title":"Complications associated with use of levamisole-contaminated cocaine: an emerging public health challenge","volume":"87","author":"Lee","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"2019112612142662000_b8-0370049","first-page":"1381","article-title":"Agranulocytosis associated with cocaine use\u2014four states, March 2008\u2013November 2009","volume":"58","author":"Centers for Disease Control and Prevention (CDC)","year":"2009","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2019112612142662000_b9-0370049","first-page":"878903","article-title":"p-ANCA-associated vasculitis caused by levamisole-adulterated cocaine: a case report","volume":"2013","author":"Carter","year":"2013","journal-title":"Case Rep Emerg Med"},{"issue":"8","key":"2019112612142662000_b10-0370049","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.5858\/arpa.2014-0107-RS","article-title":"Levamisole-induced vasculitis: a characteristic cutaneous vasculitis associated with levamisole-adulterated cocaine","volume":"139","author":"Roberts","year":"2015","journal-title":"Arch Pathol Lab Med"},{"key":"2019112612142662000_b11-0370049","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s13000-015-0279-z","article-title":"Pathologic manifestations of levamisole-adulterated cocaine exposure","volume":"10","author":"Nolan","year":"2015","journal-title":"Diagn Pathol"},{"issue":"1","key":"2019112612142662000_b12-0370049","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3121\/cmr.2012.1085","article-title":"Cutaneous vasculopathy associated with levamisole-adulterated cocaine","volume":"11","author":"Tran","year":"2013","journal-title":"Clin Med Res"},{"issue":"8","key":"2019112612142662000_b13-0370049","article-title":"Treating vasculitis arising from levamisole-contaminated cocaine","volume":"27","author":"Ellis","year":"2014","journal-title":"Podiatry Today"},{"key":"2019112612142662000_b14-0370049","unstructured":"Falk\n              PJ\n            , MerkelPA, KingTE. Clinical manifestations and diagnosis of granulomatosis with polyangiitis and microscopic polyangiitis. UpTo-Date website. http:\/\/uptodate.com\/contents\/clinical-manifestations-and-diagnosis-of-granulomatosis-with-polyangiitis-and-microscopic-polyangiitis. Updated November 15, 2016. Accessed April 25, 2017."},{"key":"2019112612142662000_b15-0370049","unstructured":"Tracey\n              CL\n            \n          . Granulomatosis with polyangiitis (Wegener granulomatosis). Medscape website. http:\/\/emedicine.medscape.com\/article\/332622. Updated November 21, 2016. Accessed April 25, 2017."},{"issue":"2","key":"2019112612142662000_b16-0370049","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.reuma.2009.02.007","article-title":"Churg-Strauss vasculitis. Description of 9 cases [in Spanish]","volume":"6","author":"Garc\u00eda-Melchor","year":"2010","journal-title":"Reumatol Clin"},{"key":"2019112612142662000_b17-0370049","unstructured":"Edlich\n              RF\n            \n          . Purpura fulminans. Medscape website. http:\/\/emedicine.medscape.com\/article\/2202749. Updated October 1, 2015. Accessed April 25, 2017."},{"issue":"1","key":"2019112612142662000_b18-0370049","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/BOR.0b013e32835b15f7","article-title":"Cryoglobulinemia vasculitis: an update","volume":"25","author":"Terrier","year":"2013","journal-title":"Curr Opin Rheumatol"},{"key":"2019112612142662000_b19-0370049","unstructured":"Movva\n              S\n            \n          . Antiphospholipid syndrome. Medscape website. http:\/\/emedicine.medscape.com\/article\/333221. Updated July 1, 2016. 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Accessed April 25, 2017."},{"key":"2019112612142662000_b23-0370049","unstructured":"Forum thread: is all coke really laced with levamisole?\n          Bluelight website. http:\/\/www.bluelight.org\/vb\/threads\/568283-Is-all-coke-really-laced-with-levamisole. Published 2011. Accessed April 25, 2017."},{"key":"2019112612142662000_b24-0370049","unstructured":"Mellick\n              L\n            \n          . Levamisole adulterated cocaine vasculitis. YouTube website. https:\/\/www.youtube.com\/watch?v=UPVVLL4FERY. Published February 18, 2015. Accessed April 25, 2017."},{"key":"2019112612142662000_b25-0370049","unstructured":"Mellick\n              L\n            \n          . Levamisole adulterated cocaine vasculitis part II. YouTube website. https:\/\/www.youtube.com\/watch?v=dd5gBQfmidw. Published February 25, 2015. Accessed April 25, 2017."},{"key":"2019112612142662000_b26-0370049","unstructured":"Cocaine cuts test kit. http:\/\/testkitplus.com\/product\/cocaine-cuts-test-kit. 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