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Link to original content: https://pubmed.ncbi.nlm.nih.gov/29211697
Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity - PubMed Skip to main page content
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Review
. 2018 Jan;25(1):29-36.
doi: 10.1097/MOH.0000000000000393.

Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity

Michael J Cascio  1 , Kuang-Yu Jen
Affiliations
Review

Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity

Michael J Cascio et al. Curr Opin Hematol. 2018 Jan.

Abstract

Purpose of review: Levamisole was previously used for its immunomodulatory properties to treat rheumatoid arthritis and some cancers. However, because of serious side-effects, it was taken off the market in the United States. Recently, levamisole has reemerged as a popular cocaine adulterant. Some individuals who consume levamisole-adulterated cocaine can develop a life-threatening autoimmune syndrome. In this review, the medical consequences of levamisole exposure and postulated mechanisms by which levamisole induces these adverse effects are discussed.

Recent findings: Although agranulocytosis and cutaneous vasculitis are the major findings in patients who develop cocaine/levamisole-associated autoimmune syndrome (CLAAS), more recent experience indicates that other organ systems can be involved as well. Current studies point to neutrophil activation and neutrophil extracellular trap formation with subsequent antineutrophil cytoplasmic antibody-mediated tissue injury as a possible mechanism of CLAAS.

Summary: In the past decade, the detrimental effects of levamisole have reemerged because of its popularity as a cocaine adulterant. Although infrequent, some individuals develop a systemic autoimmune syndrome characterized by immune-mediated agranulocytosis and antineutrophil cytoplasmic antibody-mediated vasculitis. Mechanistically, neutrophil antigens appear to be a major player in inducing CLAAS. Prompt cessation of levamisole exposure is key to treatment, although relapses are frequent because of the addictive effects of cocaine and the high prevalence of levamisole within the cocaine supply.

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