ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY POSITIVE VASCULITIS ASSOCIATED WITH LEVAMISOLE CONTAMINATION IN STREET DRUGS

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2013-04-12

Authors

White, Leon

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Abstract

Purpose: The antihelminth drug, Levamisole is widely used to cut cocaine and has been reported to cause aganulocytosis and neutropenia. It can present with an elvated perinuclear antineutrophil cytoplasmic antibody (P-ANCA), anti-nuclear antibody (ANA), myeloperoxidase (MPO), and proteinase 3 (PR3). The purpose of this communication is to demonstrate potential rheumatological side effect of cocaine use related to levamisole contamination. Methods: We present 2 cases of P-ANCA positive vasculitis in patients with heavy use of cocaine. The pertinent social history, clinical findings and laboratory data were obtained from electronic medical records by authorized physicians. A PubMed search was performed using the terms levamisole and vasculitis, cocaine and levamisole, cocaine and vasculitis, and vasculitis. Articles and cases published within the last 10 years were considered. For the epidemiological statistics, we included data reported by the National Institute on Drug Abuse (NIDA), National Survey on Drug Use and Health (NSDUH), the Center for Disease Control and Prevention (CDC) and United States Drug Enforcement Agency (DEA). Results: Two patients seen in the JPS presented with painful, purpuric skin lesions on their ears, arms, forearms and face. Laboratory assays reveal neutropenia, with a positive ANA and P-ANA. Conclusions: These cases highlight the diagnostic criteria of levamisole induced vasculitis based on the presence of neutropenia, necrotizing vasculitis, rhematological findings, social history, the lack of organ involvement and the location of the lesions. Levamisole vasculitis should be clinically distinguished from other systemic disorders such as Lupus, Wegener's granulomatosis, Churgg-Strauss, and Microscopic polyangiitis.

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