UNIGE document Scientific Article - Case report
previous document  unige:111115  next document
add to browser collection
Title

Acute coronary syndrome after levamisole-adultered cocaine abuse

Authors
Michaud, Katarzyna
Shiferaw, Kebede
Doenz, Franceso
Published in Journal of Forensic and Legal Medicine. 2014, vol. 21, p. 48-52
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 Levamisole was used to treat pediatric nephritic syndrome and rheumatoid arthritis before being withdrawn from the market due to its significant toxicity, i.e. hematological complications and vasculitis.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/pathologyAdultCocaine/blood/chemistryCocaine-Related Disorders/complicationsCoronary Vessels/pathologyDeathSudden/etiologyDopamine Agonists/adverse effects/analysisDrug ContaminationEosinophils/pathologyHumansLevamisole/adverse effects/analysisMaleMyocardium/pathologyNarcotics/blood/chemistryNatriuretic PeptideBrain/bloodPeptide Fragments/bloodPlaqueAtherosclerotic/pathologyTroponin I/bloodTryptases/blood
Identifiers
PMID: 24365689
Full text
Article (Author postprint) (377 Kb) - public document Free access
Structures
Research group Groupe Silke Grabherr (969)
Citation
(ISO format)
MICHAUD, Katarzyna et al. Acute coronary syndrome after levamisole-adultered cocaine abuse. In: Journal of Forensic and Legal Medicine, 2014, vol. 21, p. 48-52. https://archive-ouverte.unige.ch/unige:111115

7 hits

1 download

Update

Deposited on : 2018-11-21

Export document
Format :
Citation style :