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Interesting Case Rounds Meira Louis PGY 3 August 18, 2011 With thanks to Val Dias of Calgary Lab Services Triage Note PANIC ATTACK CO OF FACIAL PAIN. AND SWELLING TO LT EYE, CO OF NOT BREATHING. SPO2 100% HYPERVENTILATING – Initial Presentation Nursing Note: “Was at dentist ~2 months ago. Treated with abx – “lost them” – c/o pain in L chest & L shoulder. Dramatic presentation, writhing on bed.” EKG Two separate issues.. • Chest pain • infection Why Levamisole? Effects of Levamisole: neutropenia CMAJ. January 2010. Annals of Haem. 2011 Clinical Rheum. 2011. What about Aminorex? Back to our case • What are you going to do with your writhing patient? • What investigations do you want? • What is her disposition? • Her CBC over the next few days 6 5 Neutrophils WBC 4 3 2 1 0 1 2 3 4 5 6 Summary 1. Levamisole is now very common in our population. 2. In certain people it can cause neutropenia and vasculitis. 3. If you want to test, need a comprehensive urine drug screen ASAP. 4. Treatment is generally supportive. 5. Watch out for the possibility of pulmonary hypertension coming to a cocaine addict near you.
