Cocaine-Levamisole Thrombovasculopathy: A Report From the Southern Network On Adverse Reactions (SONAR) Project
Notice bibliographique
Résumé
Abstract Abstract 3403 Introduction: In 2008, five emergency department patients with unexplained neutropenia and thrombovasculitis were reported from Vancouver, Canada. Similar reports have appeared from San Francisco, Denver, Providence, Chicago, New York, and Los Angeles. Methods: 156 case reports of patients of unexplained thrombovasculopathy were identified from the published literature or by SONAR. Results: The average patient age was 44 years old (SD, 11 years); 65% were female. The earliest time to symptom onset was 12 hours following last cocaine use. Dermatologic findings included retiform purpura, purpuric rash, hemorrhagic bullae, or skin necrosis (59% of cases), and lesions on the ears (35% of cases), upper extremities (33% of cases), torso (22% of cases), and the nose (10% of cases). Of 79 patients with available data, 72% presented with severe neutropenia (<1500cells/μl). Among 80 persons who had serologic studies, 95% demonstrated anti-neutrophil cytoplasmic antibodies, 31% were positive for proteinase 3 antibodies, 40% were positive for myeloperoxidase antibodies, 32% were positive for IgM cardiolipin antibodies, and 20% were positive for lupus anti-coagulant. Biopsies (primarily skin) revealed thrombosis in 25%, vasculitis in 6%, and both vasculitis and thrombosis in 20%. Thirty cases tested positive for levamisole. All patients reported recent cocaine use. Treatment of 63 neutropenic patients included supportive care (6 patients; one death; 83% recovery; and 50% spontaneous relapse); G-CSF (15 patients; 100% response; 40% relapse), antibiotics (25 patients; 100% recovery; 28% relapse rate), and corticosteroids (14 patients; 100% recovery; 28% relapse rate). Among 30 persons with skin biopsies identifying thrombosis, treatments included conservative management (5 patients; 100% response rate; 33% relapse) and corticosteroids (13 patients; 100% recovery; 22% relapse rate); among 9 persons with vasculitis, treatments included conservative treatment (2 patients, both recovered no relapses) and corticosteroids (4 patients; 100% response; and 50% relapse). Among 27 persons with thrombosis and vasculitis, treatments included conservative treatment (6 patients; 100% recovery; 50% relapse) and corticosteroids (10 patients; 100% response rates; 40% relapse rate). Severe skin necrosis treatment included skin allografts (6%), above the knee amputation (1 case) and a nose amputation (1 case). One patient with agranulocytosis died of infectious complications. The DEA reports that since 2008, 93% of intercepted cocaine is contaminated with levamisole, a colorectal cancer and anti-helminthic agent. Conclusion: Cocaine-levamisole thrombovasculopathy is a new and increasingly seen syndrome seen among emergency department patients in major cities. A high index of suspicion is essential, as cocaine use may not be obvious and expensive testing and therapies initiated. Appropriate treatment would include withdrawal of cocaine, evaluation of urine samples for levamisole, and conservative management. Disclosures: Gilbert: Allergan: Consultancy; Merz Aesthetics: Consultancy; Johnson & Johnson: Consultancy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».