Cocaine/levamisole-Associated autoimmune syndrome: A disease of neutrophil-mediated autoimmunity

Michael J. Cascio, Kuang Yu Jen

Research output: Research - peer-reviewReview article

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.

LanguageEnglish (US)
Pages29-36
Number of pages8
JournalCurrent Opinion in Hematology
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Levamisole
Autoimmunity
Cocaine
Neutrophils
Antineutrophil Cytoplasmic Antibodies
Agranulocytosis
Vasculitis
Neutrophil Activation
Rheumatoid Arthritis
Antigens
Recurrence
Skin
Wounds and Injuries
Neoplasms
Therapeutics
Extracellular Traps

Keywords

  • agranulocytosis
  • cocaine
  • levamisole
  • neutrophil
  • vasculitis

ASJC Scopus subject areas

  • Hematology

Cite this

Cocaine/levamisole-Associated autoimmune syndrome : A disease of neutrophil-mediated autoimmunity. / Cascio, Michael J.; Jen, Kuang Yu.

In: Current Opinion in Hematology, Vol. 25, No. 1, 01.01.2018, p. 29-36.

Research output: Research - peer-reviewReview article

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