Pneumotox » Drug » Levamisole-adulterated/tainted cocaine

Levamisole-adulterated/tainted cocaine

See PMID 25544694, 26974713, 29099568, 29782427

Last update : 26/05/2018

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

III.b Pneumorenal syndrome (w/wo ANCAs)

III.c Hemoptysis

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VI.b Pulmonary arterial hypertension

VI.d Pulmonary vasculitis or capillaritis

VIII.i Midline destructive lesions

VIII.o Perforation of the nasal septum

VIII.ai Nasal, palatal and/or pharyngeal pathology

IX.t CNS involvement/dysfunction/damage

X.j Myopathy-Myositis-Polymyositis (see also under Xba)

X.o Neutrophilic dermatosis (Pyoderma, Sweet syndrome)

X.s Vasculitis, pulmonary (w/wo AH), extrapulmonary, systemic: ANCA-positive

X.ad Skin purpura, ecchymoses or necrosis

X.ak Dual MPO-/PR3-ANCA systemic disease/vasculitis/pseudovasculitis

XI.n Neutropenia, agranulocytosis (w/wo infection/sepsis)

XI.r Death following exposure or poisoning

XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

XII.aa Arterial (aorta, limb) vasoconstriction and/or ischemia, acute

XV.al Path: Pulmonary hypertension incl. angiomatoid vasculopathy

XV.aw Path: Skin vasculopathy/vasculitis/fibrin thrombi

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

XVIII.t Eye catcher: Purpuric/Ecchymotic/Cyanotic lesions of the earlobes and/or nose

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France