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CASE REPORT   

Minerva Forensic Medicine 2021 March;141(1):24-7

DOI: 10.23736/S2784-8922.21.01802-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Urine versus hair analysis: when hair analysis supports the diagnosis

Jennifer P. PASCALI 1 , Guido VIEL 1, Paolo FAIS 2, Giovanni CECCHETTO 1, Massimo MONTISCI 1

1 Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; 2 Unit of Legal Medicine, Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy



This report emphasizes the importance of differential diagnosis in a young man affected by severe neutropenia by exploiting forensic toxicological evaluation of hair results. The hair toxicological analyses revealed the presence of cocaine (10 ng/mg), benzoylecgonine (5 ng/mg) and levamisole (2.5 ng/mg). Levamisole, a synthetic drug originally approved by the US Food and Drug Administration as an anthelmintic agent, is still encountered as one of the main contaminants of cocaine. Levamisole toxic syndrome may include several effects, such as bone marrow suppression, severe agranulocytosis, neurological symptoms or cutaneous vasculitis. However, many physicians are not aware of this contaminant and do not take it into account when diagnosing cases of sudden severe neutropenia. The “take-home-message” in cases of sudden otherwise unexplained neutropenia is that the detection of levamisole in hair may represent the most efficient method for demonstrating a causal link with a chronic levamisole exposure, because urine conventional drug testing often fails to identify the compound due to its rapid elimination (2-3 days).


KEY WORDS: Forensic toxicology; Levamisole; Cocaine; Neutropenia

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