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Pathologic manifestations of levamisole-adulterated cocaine exposure

ᅟ: Rheumatic manifestations of cocaine have been well described, but more recently, a dramatic increase in the levamisole-adulterated cocaine supply in the United States has disclosed unique pathologic consequences that are distinct from pure cocaine use. Most notably, patients show skin lesions and...

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Autores principales: Nolan, Amber L, Jen, Kuang-Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419488/
https://www.ncbi.nlm.nih.gov/pubmed/25943359
http://dx.doi.org/10.1186/s13000-015-0279-z
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author Nolan, Amber L
Jen, Kuang-Yu
author_facet Nolan, Amber L
Jen, Kuang-Yu
author_sort Nolan, Amber L
collection PubMed
description ᅟ: Rheumatic manifestations of cocaine have been well described, but more recently, a dramatic increase in the levamisole-adulterated cocaine supply in the United States has disclosed unique pathologic consequences that are distinct from pure cocaine use. Most notably, patients show skin lesions and renal dysfunction in the setting of extremely high perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). Unexpectedly, antibodies to myeloperoxidase, the typical target of p-ANCA, are relatively low if at all present. This discrepancy is due to the fact that p-ANCA seen in association with levamisole-adulterated cocaine exposure is often directed against atypical p-ANCA-associated antigens within the neutrophil granules such as human neutrophil elastase, lactoferrin, and cathepsin G. Biopsies of the skin lesions reveal leukocytoclastic vasculitis often involving both superficial and deep dermal vessels. Renal injury most typically manifests as crescentic and necrotizing pauci-immune glomerulonephritis. In this review, the manifestations of levamisole-adulterated cocaine-induced vasculitis are discussed with an emphasis on the typical histomorphologic findings seen on biopsy. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1764738711370019.
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spelling pubmed-44194882015-05-06 Pathologic manifestations of levamisole-adulterated cocaine exposure Nolan, Amber L Jen, Kuang-Yu Diagn Pathol Review ᅟ: Rheumatic manifestations of cocaine have been well described, but more recently, a dramatic increase in the levamisole-adulterated cocaine supply in the United States has disclosed unique pathologic consequences that are distinct from pure cocaine use. Most notably, patients show skin lesions and renal dysfunction in the setting of extremely high perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). Unexpectedly, antibodies to myeloperoxidase, the typical target of p-ANCA, are relatively low if at all present. This discrepancy is due to the fact that p-ANCA seen in association with levamisole-adulterated cocaine exposure is often directed against atypical p-ANCA-associated antigens within the neutrophil granules such as human neutrophil elastase, lactoferrin, and cathepsin G. Biopsies of the skin lesions reveal leukocytoclastic vasculitis often involving both superficial and deep dermal vessels. Renal injury most typically manifests as crescentic and necrotizing pauci-immune glomerulonephritis. In this review, the manifestations of levamisole-adulterated cocaine-induced vasculitis are discussed with an emphasis on the typical histomorphologic findings seen on biopsy. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1764738711370019. BioMed Central 2015-05-06 /pmc/articles/PMC4419488/ /pubmed/25943359 http://dx.doi.org/10.1186/s13000-015-0279-z Text en © Nolan and Jen; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Review
Nolan, Amber L
Jen, Kuang-Yu
Pathologic manifestations of levamisole-adulterated cocaine exposure
title Pathologic manifestations of levamisole-adulterated cocaine exposure
title_full Pathologic manifestations of levamisole-adulterated cocaine exposure
title_fullStr Pathologic manifestations of levamisole-adulterated cocaine exposure
title_full_unstemmed Pathologic manifestations of levamisole-adulterated cocaine exposure
title_short Pathologic manifestations of levamisole-adulterated cocaine exposure
title_sort pathologic manifestations of levamisole-adulterated cocaine exposure
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419488/
https://www.ncbi.nlm.nih.gov/pubmed/25943359
http://dx.doi.org/10.1186/s13000-015-0279-z
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