REQUEST FOR PUBLIC HEALTH SURVEILLANCE

Please report patients fitting the description below to the Carolinas Poison Center, 800-222-1222.
FROM AAPCC NPDS LIST SERVE AND THE CAROLINAS POISON CENTER:

Patients presenting with agranulocytosis who have a history of cocaine abuse may have used cocaine contaminated with levamisole. Levamisole is a veterinary antihelminthic agent that can cause reversible agranulocytosis in up to 20% of people exposed. Its use is associated with lupus anticoagulant formation. Reported patients have presented with neutropenia and opportunistic and other infections. The DEA has found levamisole in cocaine samples seized in New York, Illinois, Florida, Kansas, Missouri, and in cocaine kilogram bricks seized in South America. The New Mexico Department of Health issued an alert about 11 cases in January (see: http://www.nmhealth.org/documents/agranulocytosis1-16-09.pdf, and cases are now being reported from Denver CO. Northern Alberta published a case series of levamisole poisoning last month (see: http://www.annals.org/cgi/content/full/150/4/287).