Severe ANCA Associated Vasculitis in the Setting of Cocaine Abuse: A Case Report

Abstract

Introduction: Cocaine is a drug that is abused by 5 million Americans and most of the cocaine that comes to the United States has been tainted with Levamisole, a veterinary anti-helmintic, which recently has been linked to ANCA Associated Vasculitis (AAV) [1]. AAV is an unusual necrotizing vasculitis that attacks small vessels more often, and can have an ominous prognosis if left untreated [2].

Pulmonary-Renal Syndrome from Levamisole-Adulterated Cocaine-Induced Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review

“…Cutaneous and musculoskeletal involvement each occurred in 50% of cases. Two cases (25%) had both arthralgia and skin lesions consisting of erythema to purpura/necrosis on the face and extremities [ 25 , 29 ]. The most common skin biopsy finding reported was leukocytoclastic vasculitis.…”

“…Causes of acute renal failure in LAC-induced vasculitis are manifold, including crescentic pauci-immune glomerulonephritis (as is classic in primary AAV), but also crescentic immune-complex mediated glomerulonephritis, membranous nephropathy, and thrombotic microangiopathy [ 15 ]. The simultaneous occurrence of DAH and RPGN as a combined PRS in LAC-induced AAV is exceedingly rare [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] and, as such, may go unrecognized and be treated as primary AAV by many rheumatologists and other clinicians. However, existing treatment paradigms for LAC-induced AAV and primary AAV differ; the mainstay of treatment for the former is the discontinuation of cocaine use, while the latter is treated with systemic immunosuppression, typically including glucocorticoids, a choice of rituximab or cyclophosphamide, and consideration of the addition of the C5a receptor inhibitor, avacopan [ 4 , 15 , 33 , 34 ].…”