Nancy Y. Zhu, MD; Donald F. LeGatt, PhD; A. Robert Turner, MD
Acknowledgment: The authors acknowledge colleagues from the University of Alberta Division of Hematology, University of Alberta, and DynaLIFEDX Toxicology laboratories; the Royal Canadian Mounted Police; and the Canadian and U.S. governments for helpful assistance.
Potential Financial Conflicts of Interest: None disclosed.
Table. Clinical Details of Patients With Febrile Agranulocytosis Associated With Use of Cocaine Adulterated With Levamisole
Photographs of bone marrow aspirate (top) and trephine biopsy (bottom) from a patient with agranulocytosis and levamisole found in the urine.
Neutrophils and bands are almost completely absent. The abundance of granulocytic precursors suggests toxin-related impairment of granulopoiesis with reduction of neutrophil maturation. The remainder of the bone marrow shows normal heterogeneity. Top. Bone marrow aspirate (May-Grünwald–Giemsa stain). Bottom. Bone marrow trephine biopsy (hematoxylin–eosin stain).
Zhu NY, LeGatt DF, Turner AR. Agranulocytosis After Consumption of Cocaine Adulterated With Levamisole. Ann Intern Med. 2009;150:287–289. doi: https://doi.org/10.7326/0003-4819-150-4-200902170-00102
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Published: Ann Intern Med. 2009;150(4):287-289.
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