Division
East Florida
Hospital
HCA Florida Lawnwood Hospital
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
agranulocytosis, neutropenia, cocaine, drug abuse
Disciplines
Internal Medicine | Mental Disorders
Abstract
Introduction: Cocaine use in the United states is seen in many cases within the hospital system. Typically, they present with tachycardia, hypertension, sweating, even heart attack. Due to the uncontrolled sale and distribution of drugs, patients can be exposed to other additives in drugs which can lead to unexpected complications. Cocaine laced with levamisole (an antiparasitic drug used in veterinary medicine) can lead to agranulocytosis and neutropenia. Cocaine being the second most used illegal drug following marijuana it may be much more common than we think. Millions of individuals use cocaine yearly and develop a heavy addiction with use of other drugs as well. These undetectable combinations can be life-threatening and misleading in treatments and procedures that patients undergo within the hospital system.
Case Description: The patient is a 60-year-old male who presented to the facility complaining of abdominal pain. He previously had visited the facility several days prior and was discharged and diagnosed with constipation. He continued to have abdominal pain and constipation. The patient was found to have WBC count of less than 1. A drug screen was positive for cocaine use. As the patient improved with fluids, and a bowel regimen the patient continued to have undetectable WBC level and eventually became neutropenic with a fever. The patient was placed on appropriate precautions and antibiotics and recovered.
The patient remained in the hospital setting for additional testing and continued to come back negative for sexually transmitted illnesses and bone marrow biopsy was negative for any infiltration or pathology. After extensive discussion regarding his medical history, the patient discussed with both the primary and hematology team that he was a long-term cocaine user and had different sources for obtaining the drug. After more than a week in the hospital the patient’s WBC count began to rise within normal reference range. The patient recovered and was counseled extensively and had great family support within and out of the hospital.
Discussion: The patient’s case demonstrates and importance of understanding that typical drug use does not present in the manner which we may be accustomed. It is important for clinicians to understand and recognize that patients consume drugs that may be laced with other drugs that are not commonly seen within the hospital setting and that the side effects can be life-threatening in ways for which are not expected. A thorough discussion on patient drug use can be very uncomfortable and awkward at times but it proves to be essential in understanding what is happening to patients, how to diagnose, treat, and avoid unnecessary tests for the patient. This also provides tools for physicians to use as counseling for drug cessation
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Gomez Alvarez, Maria; Govan, Ashish; and LaRocque, Raymond, "Cocaine Induced Agranulocytosis and Neutropenia" (2025). East Florida Division GME Research Day 2025. 41.
https://scholarlycommons.hcahealthcare.com/eastflorida2025/41