Severe panarteritis associated with drug abuse

Abstract

A case of panarteritis with purpura fulminans, mononeuritis multiplex, gastrointestinal manifestation and presumably cardiac involvement in a previously healthy 22-year-old man with a history of drug abuse including cocaine, cannabinoids and methamphetamines is described. Histopathological examination of the gut led to the diagnosis of panarteritis without immune deposits. Antineutrophil antibodies were negative. Besides the drugs, no other possible cause of vasculitis was found. The patient recovered completely after 1 year. Drug abuse is a thus possible cause of severe extracerebral disabling vasculitis.

Massive Spontaneous Perirenal Hematoma and Accelerated Hypertension in a Patient with Polyarteritis nodosa

“…Some authors suppose that there is a relationship between pharmacological toxicity and renal damage, but there is no certainty about that. In some reports different kinds of vasculitis related to drug abuse (heroin, cannabinoids, and methamphetamines) [12,13] and antibiotic use (rifampicin, isoniazid, streptomycin, and metronidazole) are described [14]. In our patient, the complications due to vasculitis became appearent after 2 weeks of treatment with rifampicin and isoniazid, and a correlation between reactivation of PAN and drug administration could be hypothesized.…”

A Case of Suspected Mononeuritis Multiplex in a Teenager From Polysubstance Abuse

“…Mononeuritis multiplex (MNM) is the classic manifestation of vasculitic peripheral neuropathy. Clinical features include asymmetric sensory‐motor dysfunction [1,3,5,7‐9]. The electrodiagnostic study is consistent with nonlength‐dependent asymmetric sensory‐motor multifocal axonopathy [1,4,7].…”

“…Generally, this type of neuropathy has a good prognosis, and those affected will gradually recover function. Drug abuse‐related MNM has been found to have a hypersensitivity‐type vasculitis [3,5,9]. Hypersensitivity vasculitis secondary to infection or toxin results from the formation of immune reactions‐immune complexes with antigen found in blood vessel walls and then the activation of polymorphonuclear leukocytes.…”

“…Secondary etiologies include rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, sarcoidosis, and systemic sclerosis [2]. Drug‐induced vasculitis is a rare but a known cause of peripheral neuropathy [3‐6].…”