• Nicola S Vos, Eric A F Haak, and Onno C Leeksma.
• Onze Lieve Vrouwe Gasthuis, Amsterdam.
• Ned Tijdschr Geneeskd. 2014 Jan 1;158:A7430.

BackgroundSince 2009, a warning has been issued about cocaine that has been adulterated with levamisole, mainly in the USA and Canada. Agranulocytosis occurs as an idiosyncratic reaction in 3-10% of patients exposed to levamisole.Case DescriptionA 36-year-old man was referred to our hospital because of an episode of high fever and infections on his hands, mouth and ears. Laboratory testing showed neutropenia. The infections were treated successfully with antibiotics. The neutropenia disappeared, but returned with recurrence of the infections. Upon presentation at the emergency care unit, the patient had signs of intoxication. This patient's urine contained metabolites of cocaine (benzoylecgonine and ecgonine methyl ester), whereupon additional testing showed levamisole to be present in serum. The patient discontinued cocaine use. Following treatment of the infections, the neutropenia fully resolved and did not recur.ConclusionThis patient had acquired agranulocytosis, due to the use of cocaine adulterated with levamisole.

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