Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis.

• Type of Material: Article
• Authors: Gillian G. Baptiste Gillian G. Baptiste, Emory University; Anastasia-Stefania Alexopoulos, Emory University; Tahsin Masud, Emory University; Joanna Bonsall, Emory University
• Language: English
• Date: 2015
• Publisher: Hindawi Publishing Corporation
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Gillian G. Baptiste et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1155/2015/547023
• Title of Journal or Parent Work: Case Reports in Medicine
• ISSN: 1687-9627
• Volume: 2015
• Start Page: 547023
• End Page: 547023
• Research Categories: Health Sciences, Human Development; Health Sciences, General

Abstract

Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-adulterated cocaine have previously been reported in the literature, classically characterized by a retiform purpuric rash. We report a case of a crack-cocaine user without cutaneous abnormalities who developed ANCA-associated glomerulonephritis that progressed to renal failure. This case demonstrates the difficulties in solidifying the diagnosis of levamisole-induced vasculitis in the absence of cutaneous findings and the need to pursue more testing to establish causality in ANCA-associated vasculitis that has potential for severe end-organ damage in patients who continue to use cocaine.