Clinicopathologic Features of Agranulocytosis in the Setting of Levamisole-Tainted Cocaine

被引：68

作者：

Czuchlewski, David R. ^{[1
]}

Brackney, Monica ^{[3
]}

Ewers, Christina ^{[3
]}

Manna, Jonaki ^{[4
]}

Fekrazad, M. Houman ^{[2
]}

Martinez, Afton ^{[3
]}

Nolte, Kurt B. ^{[1
]}

Hjelle, Brian ^{[1
]}

Rabinowitz, Ian ^{[2
]}

Curtis, Brian R. ^{[5
]}

McFarland, Janice G. ^{[5
]}

Baumbach, Joan ^{[3
]}

Foucar, Kathryn ^{[1
]}

机构：

[1] Univ New Mexico, Dept Pathol, Hlth Sci Ctr, Albuquerque, NM 87131 USA

[2] Univ New Mexico, Div Hematol Oncol, Hlth Sci Ctr, Albuquerque, NM 87131 USA

[3] New Mexico Dept Hlth, Santa Fe, NM USA

[4] Vancouver Isl Hlth Author, Vancouver, BC, Canada

[5] Blood Ctr Wisconsin, Milwaukee, WI USA

来源：

AMERICAN JOURNAL OF CLINICAL PATHOLOGY | 2010年 / 133卷 / 03期

关键词：

Agranulocytosis; Levamisole; Cocaine; CANCER; NEUTROPENIA; ANTIBODIES; FARMS;

D O I：

10.1309/AJCPOPQNBP5THKP1

中图分类号：

R36 [病理学];

学科分类号：

100104 ;

摘要：

Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency. We identified 20 cases of unexplained agranulocytosis in our practice locations of Albuquerque, NM, and Vancouver, Canada. Epidemiologic investigation revealed recent or ongoing cocaine use in 14 cases (70%). Certain morphologic features, including circulating plasmacytoid lymphocytes, increased bone marrow plasma cells, and mild megakaryocytic hyperplasia, were associated with the cocaine-exposed group. Of 5 patients tested, 3 (60%) were HLA-B27+ and showed antineutrophil antibodies, consistent with known associations of levamisole-induced agranulocytosis. One patient, Who was positive for Cocaine and levamisole by toxicology; testing, died of infectious complications. Inadvertent consumption of levamisole via cocaine is a severely underappreciated risk factor for agranulocytosis, and specific laboratory features are suggestive of this etiology.

引用

页码：466 / 472

页数：7

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