Clinical Profile of Levamisole-Adulterated Cocaine-Induced Vasculitis/Vasculopathy

Muñoz-Vahos, Carlos Horacio; Herrera-Uribe, Sebastián; Arbeláez-Cortés, Álvaro; Jaramillo-Arroyave, Daniel; González, Luis Alonso; Vásquez-Duque, G.; Restrepo-Escobar, Mauricio; Correa-Londoño, Luis Alfonso; Arias-Restrepo, Luis Fernando; Vanegas-García, Adriana L.

doi:10.1097/rhu.0000000000000813

Cited by 38 publications

(49 citation statements)

References 37 publications

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“…However, a distinctive Retiform (net-like) purpuric rash involving the pinnae is common (73%) and highly suggestive of LIV. 56,57 Abstention from Cocaine (and thus also from Levamisole) is key to the successful treatment of both CIMDL and LIV, and patients should be offered professional support from substance misuse teams. For some patients, abstention from cocaine may alone be sufficient to induce remission, 58 and ongoing cocaine use is a major cause of refractory or relapsing disease.…”

Section: Drug-induced Vasculitis Associated With Cocaine Abuse: Cocmentioning

confidence: 99%

“…For some patients, abstention from cocaine may alone be sufficient to induce remission, 58 and ongoing cocaine use is a major cause of refractory or relapsing disease. 57 Beyond the requirement for abstention from cocaine, the management of these cocaine-use associated vasculitic conditions is not well established. However, patients with LIV are often treated with high dose corticosteroids acutely.…”

Section: Drug-induced Vasculitis Associated With Cocaine Abuse: Cocmentioning

confidence: 99%

“…In contrast, Levamisole‐induced vasculitis is a systemic vasculitis which shares many similarities with GPA. However, a distinctive Retiform (net‐like) purpuric rash involving the pinnae is common (73%) and highly suggestive of LIV 56,57 …”

Section: What Other Differential Diagnoses Should I Consider?mentioning

confidence: 99%

“…Abstention from Cocaine (and thus also from Levamisole) is key to the successful treatment of both CIMDL and LIV, and patients should be offered professional support from substance misuse teams. For some patients, abstention from cocaine may alone be sufficient to induce remission, 58 and ongoing cocaine use is a major cause of refractory or relapsing disease 57 . Beyond the requirement for abstention from cocaine, the management of these cocaine‐use associated vasculitic conditions is not well established.…”

Section: What Other Differential Diagnoses Should I Consider?mentioning

confidence: 99%

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Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Coates

Pero

2020

Clinical Otolaryngology

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ENT involvement is common in ANCA-associated vasculitis (AAV), particularly in GPA and EGPA. Early recognition and treatment is important for good outcomes, yet evidence suggests that UK ENT surgeons may not consistently recognise the early features of AAV, despite a similar incidence to vestibular schwannoma. AAV is a rapidly advancing field, with significant developments in the understanding of its pathogenesis, classification and treatment over the past decade. Relevant vasculitis mimics are also discussed with a particular focus on the increasing prevalence of vasculitis mimics driven by an increase in recreational cocaine use, as well as the emergence and reclassification of several other vasculitis mimics in the head and neck. This article reviews key recent updates in the vasculitis literature, with a particular focus on those relevant to recognition and diagnosis of AAV for the ENT surgeon. Strengths and limitations of relevant diagnostic testing are discussed, and a method of evaluation of patients with features of AAV presenting to ENT services is outlined. | 317

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Section: Drug-induced Vasculitis Associated With Cocaine Abuse: Cocmentioning

confidence: 99%

Section: Drug-induced Vasculitis Associated With Cocaine Abuse: Cocmentioning

confidence: 99%

Section: What Other Differential Diagnoses Should I Consider?mentioning

confidence: 99%

Section: What Other Differential Diagnoses Should I Consider?mentioning

confidence: 99%

See 2 more Smart Citations

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Coates

Pero

2020

Clinical Otolaryngology

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“…Cocaine use is related to other systemic damage, such as damage to the orbital cavity midline, necrosis of the hard and soft palate, pulmonary toxicity, hepatotoxicity, cardiovascular toxicity, and central nervous system toxicity 7 . Cocaine adulterated with levamisole is associated with retiform purpura, leukopenia and agranulocytosis, and alveolar hemorrhage 8 .…”

Section: Discussionmentioning

confidence: 99%

Rapidly progressive glomerulonephritis and acute kidney injury associated with cocaine use - Case report

et al. 2021

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ABSTRACT A wide spectrum of renal complications can occur with acute and chronic use of cocaine. Most cases are related to rhabdomyolysis, but other mechanisms are malignant hypertension, renal ischemia, and rapidly progressive glomerulonephritis (RPGN) associated-ANCA vasculitis. In recent years, the use of cocaine adulterated with levamisole has been associated with ANCA vasculitis and pauci-immune RPGN. RPGN is clinically manifested as a nephritic syndrome with a rapid and progressive decline in renal function, and its histopathological finding is the presence of crescents in more than 50% of the glomeruli. We report a case of a 38-year-old man chronic user of cocaine, alcohol, and cigarettes who had red urine, oliguria, swollen legs and eyelids, as well as the uremic symptoms anorexia, emesis, and mental confusion. He was admitted with acute kidney injury and performed six hemodialysis sessions during the first 16 days of hospitalization and then was transferred to a tertiary hospital for diagnostic investigation. Tests of ANF (antinuclear factor), ANCA, anti-DNA, serology for hepatitis B, C, and HIV virus were negative. A renal percutaneous biopsy revealed crescentic glomerulonephritis with mild tubular atrophy. The patient underwent pulse therapy with methylprednisolone (for 3 days) and cyclophosphamide. Then he maintained daily prednisone and monthly intravenous cyclophosphamide and evolved with progressive improvement of renal function.

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Levamisole-Induced Vasculopathy

López‐Sánchez

Rozas‐Muñoz²,

Mir-Bonafé

2021

JAMA Dermatol

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A man in his 40s presented to the emergency department with rapidly progressive painful skin lesions and malaise. He was a long-term cocaine user, with last use in the previous day; he had no other medical history. Physical examination revealed tender retiform plaques with a necrotic center and purpuric surrounding discoloration on his cheeks and ears (Figure ), nose, arms, buttocks, and limbs. The results of laboratory investigations revealed normocytic anemia, thrombocytopenia, acute-phase reactant elevation, and impaired kidney function with proteinuria. Urine toxicology results were positive for cocaine and levamisole. The autoimmune workup revealed positive perinuclear

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Clinical Profile of Levamisole-Adulterated Cocaine-Induced Vasculitis/Vasculopathy

Cited by 38 publications

References 37 publications

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Updates in antineutrophil cytoplasmic antibody (ANCA)‐associated vasculitis for the ENT surgeon

Rapidly progressive glomerulonephritis and acute kidney injury associated with cocaine use - Case report

Levamisole-Induced Vasculopathy

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