The Drug-Induced Respiratory Disease Website

Levamisole-adulterated/tainted cocaine

Arterial (aorta, limb) vasoconstriction and/or ischemia, acute

May involve the aorta or limb arteries causing renal, bowel, limb, brain and/or coronary ischemia

McMullin CM, Bayat I, Rytina E, See TC, Varty K, Coughlin PA

Profound acute limb ischemia affecting all four limbs following cocaine inhalation.

Journal of vascular surgery 2015 Feb;61;504-6 — 2015 Feb — 504-6

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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