Toxicological Diagnosis of Severe Neutropenia Due to Levamisole

Abstract

Introduction: Levamisole toxic syndrome may include several effects, such as bone marrow suppression, severe agranulocytosis, neurological symptoms, or cutaneous vasculitis. Methodology: This report emphasizes the importance of differential diagnosis in young patients with severe neutropenia by hair toxicological analyses. These analyses can reveal the presence of cocaine and his metabolites but also sometime levamisole, a synthetic drug, originally approved by the US Food and Drug Administration as an anthelmintic agent that is still encountered as one of the main contaminants of cocaine. Many physicians are not aware of this contaminant and do not take it into account when diagnosing cases of sudden severe neutropenia. Results: In cases of sudden otherwise unexplained neutropenia, the detection of levamisole in hair may represent the most efficient method for demonstrating the toxic effect of chronic levamisole exposure, because urine conventional drug testing often fails to identify the compound due to its rapid elimination (2-3 days).