Recurrent Febrile Neutropenia and Thrombocytopenia in a Chronic Cocaine User: A Case of Levamisole Induced Complications

Table 1

Comparison of characteristics during the three admissions.

	Admission number 1	Admission number 2	Current admission
Presentation	Fever and sore throat	Fever, neck stiffness, cough, macular rash with whitish central papules on chest and extremities	Fever, gluteal abscess
WBC (ANC)	2.8 k/uL (600 cells/uL)	1.9 k/uL (100 cells/uL)	1.3 k/uL (100 cells/uL)
Platelets lowest	176 k/uL	53 k/uL	33 k/uL
Urine toxicology	Cocaine and cannabinoids	Cocaine	Cocaine and cannabinoids
Imaging	Chest X-ray-negative	Chest X-ray-negative	Chest X-ray-negative
	Chest CT negative	CT head-negative
	Abdomen/pelvis CT-possible colitis	CT facial bones negative	Abdomen/pelvis CT-perianal abscess
		Echocardiogram-normal	Echocardiogram-normal
Serology-negative	HIV-negative; Thyroid panel-normal; Cardiac markers-negative	HIV, HTLV, BCR-abl, malaria smear, dengue titer, hepatitis panel serum cryptococcal antigen, collagen vascular disease work-up negative, RPR	ANCA, ANA, MPO, antiphospholipid antibodies, anti-cardiolipin, complement, HLA B27, malaria, hepatitis, HIV, HTLV-all negative
Other tests		Flow cytometry neg.	Flow cytometry neg.
Urine and serum for levamisole	Not done	Not done	Sent at day 5 of admission-negative
Cultures-blood, urine, stools	Negative	Negative	Negative
Procedures	None	Spinal tap normal	Perianal abscess drainage at the bed side
		Bone marrow biopsy ×2; (hypercellular marrow with myeloid predominance and trilineage maturation)
Antibiotics	Ciprofloxacin; Metronidazole; Moxifloxacin	Vancomycin, meropenem, acyclovir, fluconazole, doxycycline, daptomycin, metronidazole, cefepime, clindamycin	Vancomycin, cefepime,; Zosyn, caspofungin,; amikacin, and meropenem
G-CSF (duration-days)	Not given	5 days of administration	8 days of administration
Others			Platelets transfusion
Hospital complications	None	None	Acute renal failure. Serum Creatinine
			Gastrointestinal bleeding
Fever resolution-time days	2 days	8 days	7 days
Outcome	Discharged after 4 days-symptoms improved	Discharged after 23 days-symptoms improved	Discharged after 16 days-symptoms improved, abscess healing

ANA = antinuclear antibodies; ANCA = antineutrophil cytoplasmic antibodies; HIV = human immunodeficiency virus; HTLV = human T-lymphotropic virus; MPO = anti-myeloperoxidase; human leukocyte antigen B27.