Cocaine-induced Churg-Strauss vasculitis

Abstract

A freebase cocaine-smoking woman developed relapsing fever, bronchoconstriction, arthralgias and weight loss. Pulmonary infiltrates, arthritis, microhaematuria, pruriginous skin rash and mononeuritis multiplex were later added to the clinical picture. Both skin and muscle biopsies showed eosinophilic angiitis. Improvement or worsening of her clinical picture repeatedly coincided with avoidance or use of smoked cocaine, respectively.We suggest that Churg-Strauss vasculitis may be a complication of smoking freebase cocaine. Eur Respir J., 1996, 9, 175-177 Various lung diseases related to the use of freebase cocaine have been reported [1,2]. Pulmonary infiltration with eosinophilia is an uncommon presentation of cocaine smoking [3][4][5][6]. We report a case of Churg-Strauss vasculitis in a patient whose clinical symptoms were clearly related to cocaine smoking. To our knowledge, this effect of cocaine abuse has not been described previously. Case reportA 39 year old woman had been a 40 cigarette·day -1 smoker since the age of 16 yrs. She had been using cocaine for the last 14 yrs and denied other toxic exposures and i.v. drug abuse. Her initial cocaine use had been limited to intranasal administration. Since then, she had occasionally suffered from wheezing which remitted with the inhalation of adrenergic β 2 -agonists. She had begun to use freebase "smoked" cocaine 8 months earlier. Shortly afterwards, she presented with dyspnoea on effort, wheezing, 20 kg weight loss and polyarthralgias. The patient was admitted because of sweats, 38˚C fever, dry cough and right pleuritic pain of 1 week's duration.Physical examination showed right inspiratory crackles and diffuse expiratory wheezes. Nasal examination was normal. Chest radiography disclosed an alveolar infiltrate in the right lower lobe. Electrocardiography (ECG) revealed tachycardia at 110 beats·min -1 with diffuse repolarization changes. Pulmonary function testing showed a forced vital capacity (FVC) of 2.6 L (79% of predicted) forced expiratory volume in one second (FEV1) 2.0 L (70% pred) and FEV1/FVC 77%. Arterial blood gas measurements performed with the patient breathing room air were: pH 7.42; arterial carbon dioxide tension (Pa,CO 2 ) 5.6 kPa (42 mmHg) and arterial oxygen tension (Pa,O 2 ) 6.9 kPa (52 mmHg). Leucocyte count was 11.9×10 9 cells·L -1 with 3% eosinophils, and serum immunoglobulin E (IgE) was 346 IU·mL -1 . Erythrocyte sedimentation rate (ESR) was 99 mm·h -1 . All bacteriological studies were negative. Testing for human immunodeficiency virus was also negative.The patient stopped smoking cocaine and was treated with bronchodilators and antibiotics. Marked clinical and radiological improvement was observed within a few days and the patient was discharged. Temporal relationship between cocaine exposure and laboratory data is shown in figure 1.Six months later, the patient began to smoke cocaine again and presented with three episodes of fever, cough, wheezing, arthralgias and peripheral lung infiltrates ( fig. 2),

Histopathological Changes Of Cerebral Vessels Secondary To Drug Abuse

“…Cerebral vasculitis has been associated with amphetamines (5), ephedrine (6), heroin (7), phenylpropanolamine (8), lysergic acid diethylamide (LSD) but also with multiple substance abuse (9). Particularly, cocaine abuse has also been associated with other types of vasculitis such as necrotizing vasculitis in Schoenlein-Henoch purpura (10), Churg-Strauss vasculitis (11) and Fusarium endophthalmitis (12).…”

Cocaine-Related Stevens-Johnson Syndrome

“…Histology showed vasculitis, in 1 case considered typical of hypersensitivity vasculitis [12]. Furthermore, cocaine use has also been reported in association with Churg-Strauss vasculitis [13]and palpable purpura [14]. Necrotizing vasculitis of the Henoch-Schönlein type has been reported as cutaneous vasculitis following cocaine snorting [15].…”

Dermatologic Signs and Symptoms of Substance Abuse

“…Cocaine is also associated with vasculitides, such as urticarial vasculitis [53], retiform purpura [54], scleroderma [32,55], Raynaud's phenomenon [56], Churg-Strauss [57], and a P-ANCA positive Wegener granulomatosis-like syndrome [58,59]. P-ANCA specifically against human neutrophil elastase distinguishes cocaine-induced dermatologic and rheumatologic diseases from primary autoimmune diseases [59].…”