Levamisole-adulterated cocaine nephrotoxicity: Ultrastructural features

Yi Wei Justin Liu, Sangeeta Mutnuri, Sarah Batool Siddiqui, Geoff Richard Weikle, Olajumoke Oladipo, Niharika Ganti, Robert E. Beach, Marjan Afrouzian

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: The issue of levamisole-adulterated cocaine is emerging as a rapidly growing public health concern due to an increasing number of reports describing its role in cutaneous vasculitis and agranulocytosis. Of note, levamisole is recognized as a contaminant in 69% of the cocaine used within the United States. Methods: We describe a patient who was a chronic cocaine user and developed systemic vasculitis characterized by polyarthralgia, bullous skin lesions, agranulocytosis, and antineutrophil cytoplasmic antibody-positive rapidly progressive glomerulonephritis. Results: The skin biopsy specimen demonstrated leukocytoclastic vasculitis. The renal biopsy specimen revealed pauci-immune necrotizing and crescentic glomerulonephritis and unusual deposits with medium electron density composed of granules, microspherules, and rare single fibrils on electron microscopy. Conclusions: The electron microscopic features of levamisole-adulterated cocaine toxicity are novel findings that are presented for the first time, to our knowledge, in this report.

Original languageEnglish (US)
Pages (from-to)720-726
Number of pages7
JournalAmerican journal of clinical pathology
Issue number5
StatePublished - May 1 2016


  • Cocaine
  • Cutaneous vasculitis
  • Electron microscopy
  • Levamisole
  • Pauci-immune

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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