{"id":"https://openalex.org/W2592990062","doi":"https://doi.org/10.1182/blood.v116.21.1421.1421","title":"Levamisole Adulterated In Cocaine Causing Agranulocytosis, Vasculopathy and Acquired Protein S Deficiency","display_name":"Levamisole Adulterated In Cocaine Causing Agranulocytosis, Vasculopathy and Acquired Protein S Deficiency","publication_year":2010,"publication_date":"2010-11-19","ids":{"openalex":"https://openalex.org/W2592990062","doi":"https://doi.org/10.1182/blood.v116.21.1421.1421","mag":"2592990062"},"language":"en","primary_location":{"id":"doi:10.1182/blood.v116.21.1421.1421","doi":"https://doi.org/10.1182/blood.v116.21.1421.1421","is_oa":false,"landing_page_url":"https://doi.org/10.1182/blood.v116.21.1421.1421","pdf_url":null,"source":{"id":"https://openalex.org/S200071133","display_name":"Blood","issn_l":"0006-4971","issn":["0006-4971","1528-0020"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Blood","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5034510022","display_name":"Irene Ang Dy","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Irene Dy","raw_affiliation_strings":["Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5008304955","display_name":"Venkata Kiran Pokuri","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Venkata Pokuri","raw_affiliation_strings":["Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5012662818","display_name":"Eric O. Gamboa","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Eric O. Gamboa","raw_affiliation_strings":["Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA","institution_ids":[]}]},{"author_position":"last","author":{"id":null,"display_name":"John Olichney","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"John Olichney","raw_affiliation_strings":["Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Hematology Oncology, St. Luke's Roosevelt Hospital, New York, NY, USA","institution_ids":[]}]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5008304955"],"corresponding_institution_ids":[],"apc_list":{"value":5500,"currency":"USD","value_usd":5500},"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.44028304,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"116","issue":"21","first_page":"1421","last_page":"1421"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10697","display_name":"Vasculitis and related conditions","score":0.8184000253677368,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10697","display_name":"Vasculitis and related conditions","score":0.8184000253677368,"subfield":{"id":"https://openalex.org/subfields/2740","display_name":"Pulmonary and Respiratory Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12919","display_name":"Blood disorders and treatments","score":0.04179999977350235,"subfield":{"id":"https://openalex.org/subfields/1311","display_name":"Genetics"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T10800","display_name":"Forensic Toxicology and Drug Analysis","score":0.018200000748038292,"subfield":{"id":"https://openalex.org/subfields/3005","display_name":"Toxicology"},"field":{"id":"https://openalex.org/fields/30","display_name":"Pharmacology, Toxicology and Pharmaceutics"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/levamisole","display_name":"levamisole","score":0.968999981880188},{"id":"https://openalex.org/keywords/cocaine-adulteration","display_name":"cocaine adulteration","score":0.8259999752044678},{"id":"https://openalex.org/keywords/agranulocytosis","display_name":"agranulocytosis","score":0.9959999918937683},{"id":"https://openalex.org/keywords/neutropenia","display_name":"neutropenia","score":0.8370000123977661},{"id":"https://openalex.org/keywords/protein-s-deficiency","display_name":"protein S deficiency","score":0.8619999885559082},{"id":"https://openalex.org/keywords/lupus-anticoagulant","display_name":"lupus anticoagulant","score":0.9290000200271606},{"id":"https://openalex.org/keywords/antineutrophil-cytoplasmic-antibodies","display_name":"antineutrophil cytoplasmic antibodies","score":0.8700000047683716},{"id":"https://openalex.org/keywords/small-vessel-vasculitis","display_name":"small vessel vasculitis","score":0.6499999761581421},{"id":"https://openalex.org/keywords/drug-induced-thrombosis","display_name":"drug-induced thrombosis","score":0.5460000038146973},{"id":"https://openalex.org/keywords/cocaine-abuse","display_name":"cocaine abuse","score":0.4519999921321869},{"id":"https://openalex.org/keywords/purpura","display_name":"purpura","score":0.5429999828338623}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9122740626335144},{"id":"https://openalex.org/C2781325985","wikidata":"https://www.wikidata.org/wiki/Q417097","display_name":"Levamisole","level":2,"score":0.6816322207450867},{"id":"https://openalex.org/C2777063308","wikidata":"https://www.wikidata.org/wiki/Q1435822","display_name":"Neutropenia","level":3,"score":0.5605066418647766},{"id":"https://openalex.org/C2778248108","wikidata":"https://www.wikidata.org/wiki/Q5445","display_name":"Anemia","level":2,"score":0.5006570816040039},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.4613504409790039},{"id":"https://openalex.org/C90924648","wikidata":"https://www.wikidata.org/wiki/Q120569","display_name":"Gastroenterology","level":1,"score":0.4151104688644409},{"id":"https://openalex.org/C29730261","wikidata":"https://www.wikidata.org/wiki/Q274160","display_name":"Toxicity","level":2,"score":0.12178045511245728}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1182/blood.v116.21.1421.1421","doi":"https://doi.org/10.1182/blood.v116.21.1421.1421","is_oa":false,"landing_page_url":"https://doi.org/10.1182/blood.v116.21.1421.1421","pdf_url":null,"source":{"id":"https://openalex.org/S200071133","display_name":"Blood","issn_l":"0006-4971","issn":["0006-4971","1528-0020"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Blood","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/case-report","display_name":"Case Report"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2756273726","https://openalex.org/W7095559899","https://openalex.org/W2045661427","https://openalex.org/W2763634106","https://openalex.org/W2741510390","https://openalex.org/W1994567203","https://openalex.org/W1983614707","https://openalex.org/W2098084072","https://openalex.org/W2049805479","https://openalex.org/W2513793532"],"abstract_inverted_index":{"Abstract":[0,1],"1421":[2],"More":[3],"than":[4],"2":[5],"million":[6],"Americans":[7],"use":[8],"cocaine":[9,27,63,85,106,114,136,351,370,448],"each":[10],"month.":[11],"Levamisole":[12,76,375],"is":[13,372,376,411],"a":[14,23,89,92,119,270,275,392,400,416,430,454],"veterinary":[15],"antihelminthic":[16],"agent":[17,25],"that":[18],"has":[19,35,77,202,424],"been":[20,36,79,397,426],"used":[21,37],"as":[22,56,72,453],"cutting":[24],"in":[26,84,107,293,399,446],"and":[28,46,128,162,186,205,209,222,232,241,243,260,274,289,326,339,356,391,450],"adds":[29],"bulk":[30],"to":[31,50,81,140,378,413,428,466],"powdered":[32],"cocaine.":[33,172],"It":[34],"for":[38,171,227,237,266],"the":[39,51,67,137,244,383],"treatment":[40],"of":[41,57,61,91,121,135,177,193,346,385,403,409,433,440,443,464],"colon":[42],"cancer,":[43],"rheumatoid":[44,230],"arthritis":[45],"nephrotic":[47],"syndrome.":[48],"According":[49],"Drug":[52],"Enforcement":[53],"Administration":[54],"(DEA)":[55],"July":[58],"2009,":[59],"69%":[60],"seized":[62],"lots":[64],"coming":[65],"into":[66],"United":[68],"States":[69],"contained":[70],"levamisole":[71,363,405],"an":[73,108],"added":[74],"agent.":[75],"recently":[78],"reported":[80,398,427],"cause":[82,429],"neutropenia":[83,176,290,357],"abusers.":[86],"We":[87],"report":[88],"case":[90],"severe":[93],"cutaneous":[94,124,434],"necrotizing":[95],"vasculopathy,":[96],"agranulocytosis":[97,390,410],"with":[98,118,151,181,196,257,284,382],"acquired":[99],"protein":[100,277],"S":[101,278],"deficiency":[102],"caused":[103],"by":[104],"tainted":[105],"active":[109,113,447],"abuser.":[110],"A":[111,250],"44-year-old":[112],"abusing":[115],"woman":[116],"presented":[117],"day":[120,138],"acute":[122,344],"worsening":[123],"lesions,":[125],"subjective":[126],"fever":[127],"arthralgias.":[129],"She":[130,190,200],"last":[131],"inhaled":[132],"three":[133],"bags":[134],"prior":[139],"admission.":[141],"On":[142],"examination,":[143],"she":[144],"had":[145,191],"multiple":[146],"tender":[147],"palpable":[148],"purpuric":[149,297,305],"plaques":[150,298,306],"central":[152],"necrosis":[153],"on":[154,299,307],"her":[155],"thighs,":[156],"lower":[157,301,309],"extremities,":[158],"chest,":[159],"abdomen,":[160],"arms,":[161],"bilateral":[163,300,308],"ear":[164,312,316],"helices.":[165],"Urine":[166],"toxicology":[167],"screen":[168],"was":[169,282],"positive":[170,213,271,393],"Laboratory":[173],"data":[174],"showed":[175,212,253],"1.4":[178],"\u00d7":[179],"103/uL":[180],"mild":[182],"anemia":[183,192],"(haemoglobin":[184],"12g/dl)":[185],"normal":[187,203,233],"platelet":[188],"count.":[189],"chronic":[194],"disease":[195],"negative":[197,226],"Coombs":[198],"test.":[199],"also":[201,425],"kidney":[204],"liver":[206],"functions.":[207],"Vasculitides":[208],"rheumatological":[210],"workup":[211,265],"antineutrophil":[214],"cytoplasmic":[215],"antibodies":[216],"(ANCAs)":[217],"directed":[218],"against":[219],"proteinase-3":[220],"(PR-3)":[221],"myeloperoxidase":[223],"(MPO)":[224],"but":[225],"ANA":[228],"or":[229,420],"factor":[231],"complement":[234],"levels.":[235],"Assays":[236],"syphilis,":[238],"hepatitis":[239],"B":[240],"C,":[242],"human":[245],"immunodeficiency":[246],"virus":[247],"were":[248,365],"negative.":[249],"skin":[251,287,348],"biopsy":[252,319,332],"small":[254,321,334],"vessel":[255,322,335],"thrombo-vasculopathy":[256],"organizing":[258,324,337],"thrombus":[259,325,338],"mixed":[261,327,340],"cell":[262,328,341],"infiltrate.":[263,342],"Subsequent":[264],"hypercoagulable":[267],"states":[268],"revealed":[269],"lupus":[272,394],"anticoagulant":[273,395,423],"low":[276],"activity.":[279],"The":[280,343,407],"patient":[281],"treated":[283],"steroids.":[285],"Her":[286],"lesions":[288,349],"improved":[291],"gradually":[292],"two":[294],"weeks.Figure":[295],"1.Palpable":[296],"extremities.Figure":[302,310],"1.":[303],"Palpable":[304],"2.Necrotic":[311],"helix.Figure":[313,317],"2.":[314],"Necrotic":[315],"3.Skin":[318],"showing":[320,333],"thrombovasculopathy,":[323,336],"infiltrate.Figure":[329],"3.":[330],"Skin":[331],"onset":[345],"necrotic":[347],"following":[350],"use,":[352],"ANCA":[353],"positivity,":[354],"histopathology":[355],"strongly":[358],"suggest":[359],"levamisole-induced":[360],"vasculopathy.":[361],"Although":[362],"levels":[364],"not":[366],"obtained,":[367],"exposure":[368],"from":[369],"contamination":[371],"very":[373],"likely.":[374],"known":[377],"have":[379,396],"immunostimulating":[380],"effects":[381],"production":[384],"autoantibodies":[386],"like":[387],"ANCA.":[388],"Life-threatening":[389],"few":[401],"cases":[402],"prolonged":[404],"use.":[406],"pathogenesis":[408],"hypothesized":[412],"either":[414],"be":[415,438],"direct":[417],"toxin":[418],"effect":[419],"immune-mediated.":[421],"Lupus":[422],"similar":[431],"pattern":[432],"necrosis.":[435],"Clinicians":[436],"should":[437],"aware":[439],"this":[441],"kind":[442],"clinical":[444],"presentation":[445],"abusers":[449],"consider":[451],"it":[452],"significant":[455],"emerging":[456],"public":[457],"health":[458],"problem.":[459],"Disclosures:":[460],"No":[461],"relevant":[462],"conflicts":[463],"interest":[465],"declare.":[467]},"counts_by_year":[],"updated_date":"2026-10-01T08:54:57.152042","created_date":"2017-03-16T00:00:00"}