A fatal case after an intravenous injection of levamisole
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CASE REPORT
A fatal case after an intravenous injection of levamisole Bénédicte Lelièvre1,2 · Benoit Suply3 · François Schmitt4 · Pascale Marcorelles5 · Guillaume Drevin1 · Clotilde Rougé Maillart6 Accepted: 26 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Levamisole is a drug originally prescribed as an antihelmintic. Because of the occurrence of severe cases of agranulocytosis and leukoencephalitis it was removed from the French market in 1998 for human use, while it remains available for veterinary use. Nowadays in France its only use in humans is regulated by authorization for temporary use for its immunomodulatory properties in the treatment of nephritic syndrome. A 52-year-old man was found dead at his farm. Injection points were observed on his arm and a syringe containing a dark orange-brown liquid was found near the body. At his home, the discovery of a letter highlighted suicidal intent. Analysis of the aforementioned liquid, peripheral blood and urine confirmed the unique presence of levamisole. The femoral blood concentration of levamisole was of 25 mg/L whereas the femoral blood concentrations reported in cases of fatalities after cocaine use do not exceed 0.0056 mg/L. In humans, levamisole can be detected in biological samples after cocaine use as this drug is also an adulterant and one of its metabolites (aminorex) seems to have amphetamine-like properties. In this case, the man consumed levamisole from time to time for its stimulant and strengthening effects. Cases of fatal poisoning using levamisole are very rare and poorly documented, which makes the interpretation of postmortem blood levamisole concentration difficult. Keywords Levamisole · Poisoning · Fatalities
Introduction Levamisole is a drug originally prescribed as an antihelmintic. Because of the occurrence of severe cases of agranulocytosis and leukoencephalitis, it was withdrawn from the French market for human use in 1998. Nowadays, its only
* Bénédicte Lelièvre belelievre@chu‑angers.fr 1
Pharmacology‑Toxicology Laboratory, CHU Angers, 49933 Angers, France
2
Groupe d’Etude Des Interactions Hôte‑Pathogène, UNIV Angers, UNIV Brest, Institut de Biologie en Santé-IRIS, (EA 3142) SFR ICAT 4208 , Angers, France
3
Forensic Unit of CHU Brest, Antenne GHBS Lorient, Lorient, France
4
Biochemistry Laboratory, GHBS Lorient, Lorient, France
5
Pathology department, CHU Brest, Brest, France
6
Angers University, UFR santé, medicine department, Angers, France
use in France (by authorization for temporary use) is for the treatment of nephrotic syndrome [1]. Because of its structural similarities with nicotine, the potential side effects of this drug include nausea, vomiting, sweating, hypersalivation, tachypnea, agitation, tremors, hypertension, tachycardia, and ventricular arrhythmia. In severe cases of intoxication, bradycardia, hypotension, convulsions, paralysis, respiratory paralysis, coma, and cardiovascular collapses can also occur [2, 3]. In humans, levamisole can be found i
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