Vos Nicola S, Haak Eric A F, Leeksma Onno C
Onze Lieve Vrouwe Gasthuis, Amsterdam.
Ned Tijdschr Geneeskd. 2014;158:A7430.
Since 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.
A 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.
This patient had acquired agranulocytosis, due to the use of cocaine adulterated with levamisole.
自2009年以来，主要在美国和加拿大，已发布了关于掺有左旋咪唑的可卡因的警告。在接触左旋咪唑的患者中，有3%至10%会发生粒细胞缺乏症这种特异反应。
一名36岁男性因高热以及手部、口腔和耳部感染被转诊至我院。实验室检查显示中性粒细胞减少。感染用抗生素成功治愈。中性粒细胞减少症消失，但随着感染复发又再次出现。在急诊室就诊时，患者有中毒迹象。该患者的尿液中含有可卡因代谢物（苯甲酰芽子碱和芽子碱甲酯），随后进一步检测显示血清中存在左旋咪唑。患者停止使用可卡因。在感染得到治疗后，中性粒细胞减少症完全缓解且未复发。
该患者因使用掺有左旋咪唑的可卡因而患上了获得性粒细胞缺乏症。
