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A fatal case after an intravenous injection of levamisole

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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.

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Authors and Affiliations

  1. Pharmacology-Toxicology Laboratory, CHU Angers, 49933, Angers, France

    Bénédicte Lelièvre & Guillaume Drevin

  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

    Bénédicte Lelièvre

  3. Forensic Unit of CHU Brest, Antenne GHBS Lorient, Lorient, France

    Benoit Suply

  4. Biochemistry Laboratory, GHBS Lorient, Lorient, France

    François Schmitt

  5. Pathology department, CHU Brest, Brest, France

    Pascale Marcorelles

  6. Angers University, UFR santé, medicine department, Angers, France

    Clotilde Rougé Maillart

Authors
  1. Bénédicte Lelièvre
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  2. Benoit Suply
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  4. Pascale Marcorelles
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Correspondence to Bénédicte Lelièvre.

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Lelièvre, B., Suply, B., Schmitt, F. et al. A fatal case after an intravenous injection of levamisole. Forensic Sci Med Pathol 17, 130–135 (2021). https://doi.org/10.1007/s12024-020-00336-y

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