Acute coronary syndrome after levamisole-adultered cocaine abuse.

Details

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State: Public
Version: Author's accepted manuscript
Serval ID
serval:BIB_779B7EAEEE23
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Acute coronary syndrome after levamisole-adultered cocaine abuse.
Journal
Journal of forensic and legal medicine
Author(s)
Michaud K., Grabherr S., Shiferaw K., Doenz F., Augsburger M., Mangin P.
ISSN
1878-7487 (Electronic)
ISSN-L
1752-928X
Publication state
Published
Issued date
01/2014
Peer-reviewed
Oui
Volume
21
Pages
48-52
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
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 Levamisole was used to treat pediatric nephritic syndrome and rheumatoid arthritis before being withdrawn from the market due to its significant toxicity, i.e. hematological complications and vasculitis.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.
Keywords
Acute Coronary Syndrome/chemically induced, Acute Coronary Syndrome/pathology, Adult, Cocaine/blood, Cocaine/chemistry, Cocaine-Related Disorders/complications, Coronary Vessels/pathology, Death, Sudden/etiology, Dopamine Agonists/adverse effects, Dopamine Agonists/analysis, Drug Contamination, Eosinophils/pathology, Humans, Levamisole/adverse effects, Levamisole/analysis, Male, Myocardium/pathology, Narcotics/blood, Narcotics/chemistry, Natriuretic Peptide, Brain/blood, Peptide Fragments/blood, Plaque, Atherosclerotic/pathology, Troponin I/blood, Tryptases/blood, Cocaine, Coronary artery, Eosinophils, Levamisole, Sudden death
Pubmed
Web of science
Open Access
Yes
Create date
16/01/2014 18:51
Last modification date
20/08/2019 14:34
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