He was somewhat agitated on physical exam and was noted to have necrotic lesions on both of his ears (see photo). Vital signs revealed: BP 140/90, temperature 38.7 degrees Celsius, HR 120, and Oxygen saturation of 96% on RA. His history was only notable for chronic cocaine use. J Med Toxicol 2011 29:299 – 303Ī 49 yo male presented to the emergency department for fever, chills, general malaise, weakness, and black lesions on his ears. Unfortunately, it also acts as a hapten and triggers an immune reaction causing the opsonization and destruction of white blood cells. It is also thought to increase the formation of antibodies to various antigens. Levamisole is thought to increase T-cell activation and proliferation, neutrophil mobility, adherence, and chemotaxis. Because it has immunostimulant and immunomodulatory properties, levamisole has also been used for treatment of various autoimmune disorders (rheumatoid arthritis, juvenile rheumatoid arthritis, and nephrotic syndrome) and cancers (breast and lung). Levamisole is approved by the United States Food and Drug Administration as adjuvant chemotherapy, with 5-fluorouricil, for the treatment of colon cancer.

Levamisole, the levo enantiomer of tetramisole, was originally developed as an antihelminthic agent. It can be easily purchased worldwide in various forms (tablets, gels, solutions, pastes and powders). Levamisole is a veterinary pharmaceutical used primarily to treat worm infestations in livestock. In 2008 officials in Alberta, Canada identified a cluster of unexplained cases of agranulocytosis related to cocaine contaminated with levamisole. In 2003 the Drug Enforcement Agency first detected levamisole in cocaine bricks.

Making crack with levamisole powder