Levamisole Induced Necrosis Syndrome

Levamisole Induced Necrosis Syndrome
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Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Skin necrosis, purpura, arthralgia
Complications	Infection, scarring
Onset
Duration
Types	N/A
Causes	Levamisole
Risks	Cocaine use
Diagnosis	Clinical evaluation, laboratory tests
Differential diagnosis	N/A
Prevention	N/A
Treatment	Discontinuation of levamisole, supportive care
Medication	N/A
Prognosis	Variable
Frequency	N/A
Deaths	N/A

Levamisole Induced Necrosis Syndrome (LINS) is a rare but serious condition characterized by skin necrosis and systemic symptoms, primarily associated with the use of levamisole, an antihelminthic and immunomodulatory drug. This syndrome has gained attention due to its association with levamisole-adulterated cocaine.

Pathophysiology

Levamisole is known to modulate the immune system, and its use can lead to vasculitis, a condition where blood vessels become inflamed. The exact mechanism by which levamisole induces necrosis is not fully understood, but it is believed to involve immune-mediated damage to small blood vessels, leading to tissue ischemia and necrosis.

Clinical Presentation

Patients with Levamisole Induced Necrosis Syndrome typically present with:

• Skin lesions: Painful purpuric lesions, often with central necrosis, primarily affecting the ears, face, and extremities.
• Systemic symptoms: Fever, malaise, and arthralgia.
• Laboratory findings: Neutropenia, positive antineutrophil cytoplasmic antibodies (ANCA), and elevated inflammatory markers.

Diagnosis

The diagnosis of LINS is primarily clinical, supported by a history of levamisole exposure and characteristic laboratory findings. Skin biopsy may show leukocytoclastic vasculitis, but this is not specific to LINS.

Treatment

The cornerstone of treatment is the discontinuation of levamisole. Supportive care includes wound care for necrotic lesions, pain management, and monitoring for complications such as secondary infections. In severe cases, immunosuppressive therapy may be considered.

Prognosis

The prognosis of Levamisole Induced Necrosis Syndrome varies. While some patients recover fully after discontinuation of the drug, others may experience significant scarring or complications from infections.

Epidemiology

LINS is rare, but its incidence has increased with the rise of levamisole-adulterated cocaine. It is more commonly reported in North America.

Prevention

Avoidance of levamisole, particularly in recreational drug use, is the primary preventive measure. Public health efforts to reduce cocaine adulteration with levamisole are also important.

Also see

• Vasculitis
• Cocaine
• Neutropenia
• Antineutrophil cytoplasmic antibody